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Query: UMLS:C0040425 (tonsillitis)
 1,594 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritonsillar abscess remains the most common deep infection of the head and neck. The condition occurs primarily in young adults, most often during November to December and April to May, coinciding with the highest incidence of streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is a polymicrobial infection, but Group A streptococcus is the predominate organism. Symptoms generally include fever, malaise, sore throat, dysphagia, and otalgia. Physical findings may include trismus and a muffled voice (also called "hot potato voice"). Drainage of the abscess, antibiotics, and supportive therapy for maintaining hydration and pain control are the foundation of treatment. Antibiotics effective against Group A streptococcus and oral anaerobes should be first-line therapy. Steroids may be helpful in reducing symptoms and speeding recovery. To avoid potential serious complications, prompt recognition and initiation of therapy is important. Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess. (Am Fam Physician.
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PMID:Peritonsillar abscess. 1824 91

In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative morbidity in terms of pain and bleeding. Although tonsillar tissue remains along the capsule, the outcome appears not to differ from TE, at least in the pediatric population and young adults. Age and a history of tonsillitis are not a contraindication, abscess formation in the tonsillar remnants is an extremely rare finding. The volume of the tonsils should be graded according to Brodsky and a grade >1 is considered to be eligible for TT. The number of episodes during 12 months prior to presentation is crucial to indicate either TE or TT. While surgery is not indicated in patients with less than three episodes, a wait-and-see policy for 6 months is justified to include the potential of a spontaneous healing before surgery is considered. Six or more episodes appear to justify tonsil surgery. (2) Needle aspiration, incision and drainage, and abscess tonsillectomy are effective methods to treat patients with peritonsillar abscess. Compliance and ability of the patient to cooperate must be taken into account when choosing the surgical method. Simultaneous antibiotic therapy is recommended but still subject of scientific research. Abscess tonsillectomy should be preferred, if complications have occurred or if alternative therapeutic procedures had failed. Simultaneous TE of the contralateral side should only be performed when criteria for elective TE are matched or in cases of bilateral peritonsillar abscess. Needle aspiration or incision and drainage should be preferred if co-morbidities exist or an increased surgical risk or coagulation disorders are present. Recurrences of peritonsillar abscesses after needle aspiration or incision and drainage are rare. Interval TE should not be performed, the approach is not supported by contemporary clinical studies. (3) In patients with infectious mononucleosis TE should not be performed as a routine procedure for symptom control. TE is indicated in cases with clinically significant upper airway obstruction resulting from inflammatory tonsillar hyperplasia. If signs of a concomitant bacterial infection are not present, antibiotics should not be applied. Steroids may be administered for symptom relief.
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PMID:Clinical practice guideline: tonsillitis II. Surgical management. 2688 12

The stems and roots of Marsdenia tenacissima (Roxb.) Wight et Arn., a traditional Chinese medicine and Dai herbal medicine, have been widely used for the treatment of asthma, trachitis, tonsillitis, pharyngitis, cystitis, pneumonia and drug or food poisoning. Nowadays, the extract of Marsdenia tenacissima, under the trademark of "Xiao-ai-ping", is widely used in clinic for the treatment of different cancers in China. To date, approximately 196 chemical ingredients covering steroids, triterpenes and organic acids have been identified from different parts of this plant. Steroids are the major characteristic and bioactive constituents of this plant. Modern pharmacology has demonstrated that the crude extracts and steroids have various in vitro and in vivo pharmacological activities, such as multidrug resistance reversal, antitumor, anti-angiogenic, immunomodulation and anti-HIV activities. The multidrug resistance reversal of steroids provided evidence for the use of this herb in clinic. However, despite wide clinical application, clinical trials, quality control method, pharmacokinetic and toxicity research on Marsdenia tenacissima were seldom reported and deserved further efforts. The present review aimed to achieve a comprehensive and up-to-date investigation in ethnopharmacology, phytochemistry, pharmacology, clinical study, pharmacokinetics, toxicology and quality control of Marsdenia tenacissima. In addition, the possible perspectives and trends for future studies of Marsdenia tenacissima have also been put forward. It is believed that this review would provide a theoretical basis and valuable data for future in-depth studies and applications.
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PMID:Marsdenia tenacissima: A Review of Traditional Uses, Phytochemistry and Pharmacology. 3028 70