[Treatment of patients with respiratory papillomatosis: experience analysis].
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The authors of the article analyze observations of 240 patients with respiratory papillomatosis (aged 7 months to 56 years), treated in the ETN clinic of Moscow Regional Research Clinical Institute in 1984-2003 using endolaringeal microsurgical techniques, such as ultrasound desintegration and laser photodestruction of papillomas. Additional therapy included immunocorrection with T-activin and leukomax, discrete plasmopheresis, antiviral therapy with zovirax, and photodynamic therapy. Having compared various methods and their combinations, the authors conclude that clinical recovery (no relapses within more than 2.5 years), was achieved in 41.4 +/- 0.5% - 77.8 +/- 0.2% patients.Keywords:
Recurrent Respiratory Papillomatosis
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[Current aspects and prospects of the combined treatment of respiratory papillomatosis in children].
Treatment methods and outcomes have been analyzed for 313 children aged 9 months-14 years with respiratory papillomatosis (RP) admitted to ENT clinic in 1950-1995. Beginning from 1982 papillomas were removed by means of ultrasonic disintegration. A novel approach included extracorporeal detoxication and immunocorrection. 85% of patients responded to treatment with discrete plasmapheresis and T-activin. It is concluded that best treatment results were achieved in combination of conventional methods with advanced modalities such as extracorporeal detoxication and immunocorrection.
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Detoxication
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Out of 24 patients with laryngeal papillomatosis 6 (5 female, 1 male) suffered from repeated relapses and underwent long-term treatment with alpha-IFN-therapy. Age at onset of the disease: 1 5/12-16 2/12 years. Duration of illness: 1-7 years, with several relapses were treated surgically and with laser-coagulation. Three out of 6 patients had a tracheal cannula and were cauterized by podophylline at 2-4 week intervals. IFN was given in dosages of 5-20 X 10(4) U/kg 2 or 3 times a week. IFN-dosage for each patient was determined using the induction kinetics of (2'-5')-oligo(A)synthetase (OAS) in the mononuclear cells of the circulating blood of patients with laryngeal papillomatosis. A continuous effect could be achieved by the dose of IFN determined in the described way always before OAS activity decreased to its initial level. All 6 patients responded favorably to the alpha-IFN-therapy. Two patients treated only with IFN showed remission without relapses. In 2 cases IFN was successfully used to prevent relapses after surgical treatment and laser-coagulation. In 2 patients with papillomatosis extending into the main bronchi the disease could only be brought to a standstill, i.e. it was not necessary to remove the papillomas. Two out of 3 patients with laryngeal papillomatosis could be decannulated. Long-term therapy following the above described principles is efficient and without significant side-effects. Three patients are in treatment for more than 3 10/12 years.
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Seventy three patients aged 16 to 88 years who had laryngeal papillomatosis (LP) were followed up. Microsurgical endolaryngeal removal of laryngeal papillomas was made in all the patients. The interferon inducers amixine and cycloferon as antirecurrent drugs were used in 45 patients by the regime the authors developed by taking into account the interferon status and cellular immunity of patients. The criteria for the efficiency of treatment were their improved interferon status and longer remission. The efficiency of treatment with amixine and cycloferon was 72 and 80%, respectively. Thus, the use of a sparing microsurgical intervention in combination with interferon inducers may be regarded as the method of choice in the LP treatment.
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BACKGROUND: Propanolol prescription for the treatment of several solid tumours has been increased lately trying to block VEGF. Respiratory papillomatosis have β adrenergic receptors 1 and 2 that respond theorically to propanolol generating vasoconstriction and decreasing long lasting tumour NO 2 levels, extending surgical time results. OBJECTIVE: To assess the efficacy of propanolol as adjuvant treatment of respiratory papillomatosis. MATERIAL AND METHOD: A prospective study was done including six patients in the control protocol. All patients were part of the cidofovir protocol at Pediatric Hospital of Chihuahua State, Mexico, with a follow-up of nine months to three years; all patients started treatment with propanolol after the last direct laryngoscopy and administration of cidofovir at dose of 7.5 g total in the injection. All patients had a biopsy of the lesion that confirmed the diagnosis of respiratory papillomatosis and a typification study of the virus by polymerase chain reaction. RESULTS: Five patients continued the treatment established in the protocol, and one male patient abandoned it due to hypotension and moderate bradichardia during exercise. Two of six patients required a new laryngoscopy and intralesional cidofovir. None patient has had any adverse drug reaction during protocol. CONCLUSIONS: Propanolol is a useful drug as adjuvant treatment of respiratory papillomatosis, is cheap and has little systemic effects.
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Recurrent Respiratory Papillomatosis
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Postoperative Systemic Acyclovir in Juvenile-Onset Recurrent Respiratory Papillomatosis: The Outcome
A prospective observational study was conducted consisting of 21 patients of Juvenile-onset recurrent respiratory papillomatosis, attending the Department of Otorhinolaryngology and Head Neck Surgery at our institution, who underwent surgical excision of the papillomas followed by oral acyclovir postoperatively. The study was aimed to observe the effect of systemic acyclovir on postoperative outcomes in children having recurrent respiratory papillomatosis undergoing primary surgical excision. It was observed that the mean interval between surgeries as well as the number of surgical interventions required was significantly lesser when acyclovir was used as a postoperative adjuvant than when surgery was done alone. Hence, the interval between successive surgeries, or in other words, the time interval between relapse of the disease could be prolonged significantly with the use of postoperative systemic acyclovir. Thus, the disease could be controlled for longer periods and repeated surgeries avoided.
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Abstract The antiviral drug ribavirin was used as an adjunct to laser surgery for the treatment of patients with laryngeal papillomatosis (LP). An uncontrolled clinical trial for four patients with ribavirin treatment at a daily dose of 23 mg/kg was performed. Three adults received drug prior to laser surgery and continuing orally for 6 months. One infant was treated for 3 months. Two adults achieved complete remissions for at least 2 consecutive months, and both patients developed only minimal recurrent disease in 4 months of follow‐up. The other adult and the child sustained a partial response and an increased interval between the required surgeries. Ribavirin caused only a mild, reversible reduction in hemoglobin and reticulocytosis. This preliminary trial shows that ribavirin may be an effective therapy in combination with surgery for LP in a larger controlled clinical trial.
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For 15 years the authors treated 205 children aged 9 months to 15 years with respiratory papillomatosis. Besides surgical endolaryngeal removal of the papillomas, they applied immunomodulators, plasmapheresis and antiviral drugs. Of different methods of artificial lung ventilation, the best is thought to be transcatheter high-frequency artificial lung ventilation. As shown by the studies of infection resistance, the combined treatment should incorporate such drugs as zovirax and leukomax. Ultrasound disintegration and laser photodestruction with Ho laser were introduced in surgical removal of the papillomas. The combined treatment shortens the treatment duration and prolongs recurrence-free period.
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Objectives/Hypothesis Aggressive laryngeal, tracheal, and pulmonary papilloma is an extremely challenging clinical problem without proven treatment options. A recent German report documented promising results with systemic bevacizumab. The objective of this study is to report the initial experience of this novel treatment in the United States for recurrent respiratory papillomatosis (RRP). Study Design Cases series. Methods Electronic survey of the RRP Task Force of the American Society of Pediatric Otolaryngology, American Broncho‐Esophagological Association, and physicians known to the authors to have used systemic bevacizumab for RRP. Results Eleven completed surveys were obtained. In three cases, systemic bevacizumab was considered clinically but not administered. Eight patients were treated with systemic bevacizumab, all for aggressive papillomatosis uncontrolled by surgical and adjuvant therapy, including seven of eight with pulmonary disease. Treatment dosing ranged from 5 to 10 mg/kg every 2 to 4 weeks, with all patients responding (7/8 partial response, 1/8 complete response). In four patients who had postbevacizumab chest imaging, three demonstrated improvement of disease and one stabilization. Treatment interval could be lengthened in seven patients and clinical response maintained. One patient with long‐standing pulmonary disease (>10 years) was diagnosed with malignant transformation while on treatment, and bevacizumab was discontinued in lieu of other chemotherapeutic agents. All other patients continue on systemic bevacizumab with minimal complications (hemoptysis n = 1, proteinuria n = 1). Conclusions Systemic bevacizumab appears to have significant promise in the most treatment‐resistant and aggressive forms of papillomatosis with a low complication profile. These results suggest bevacizumab should be studied in a formal clinical trial for RRP. Level of Evidence 4. Laryngoscope , 127:2225–2229, 2017
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Adjuvant Therapy
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