Tonsillectomy in Children

Abstract

Oregon goiter clinic we became interested in the relationship of pregnancy to goiter, because we had a group of children partly under school age and partly in the early school ages, which would not yield to treatment. In following up this group we discovered that a certain percentage of them were from goitrous mothers. Halsted, in 1896, observed that female dogs that had a large portion of the thyroid removed always had goitrous puppies. In the goiter clinic we have not studied a single goiter family, that is, a family in which all the children had goiters, without finding that the mother also had a thyroid defect. For this reason I believe that this problem should receive more consideration then it has in the past. The thyroid gland has two secretions, colloid and the active principle thyroxin. Whenever a demand comes on a thyroid for more thyroxin than it can secrete, the first reac¬ tion is an increase in colloid secretion; consequently, the ordinary goiter of pregnancy is a nontoxic colloid goiter. When the stimulation resulting in the oversecretion of colloid is not effective in causing an increased secretion of thyroxin, hyperplasia. occurs. Hyperplasia may be either of the cells lining the acini, or of the acini and in either case may result in a hyperthyroidism. Dr. Mussey spoke of the rarity of exophthalmic goiter in pregnancy. It is true that patients with exophthalmic goiter rarely become pregnant, but on the other hand, pregnant women often develop exophthalmic goiter. Pregnancy is an important etiologic factor. We are interested in the use of iodine in pregnancy. A woman must produce more thyroxin during pregnancy then at other times, and therefore needs a greater amount of iodine. While it is true that the taking of iodine will occasionally cause a nontoxic goiter to become toxic, the giving of iodine to pregnant women will insure normal thyroid glands in children, and we cannot afford to endanger hundreds of children because of an occasional mother who would be made toxic. Early in pregnancy we have edvised operation for all toxic goiter. I have never seen a death or an abortion follow the operating on a pregnant woman for goiter. Late in pregnancy I have advised the use of compound solution of iodine and the roent¬ gen ray if necessary.Dr. Carl Henry Davis, Milwaukee : I believe with Dr. Else that we can largely if not entirely prevent congenital goiter by the use of iodine during pregnancy. It is undoubtedly a mistake to let any adult patient continue to take iodine over an indefinite period unless under medical supervision. This explains why we have discontinued the use of iodine in most of these patients with delivery. This work will be continued, and I hope that these papers will stimulate a renewed interest in the subject all over the country, so that our textbooks will not continue to disregard this subject the way they have.Dr. Robert D. Mussey, Rochester, Minn. : Dr. Davis has presented an interesting and careful clinical study on the use of iodine in pregnancy. Continued investigation of ...

Adenotonsillectomy for upper respiratory infections: evidence based?

“…For example, in the older studies by Kaiser and Monroe,[25][26][27] inclusion criteria and outcomes are ill defined, while in the more recent studies they are better defined. 18 29 30 Despite these shortcomings the results of the more recent and better controlled studies 18 28-30 are surprisingly similar to those of the randomised trials and therefore support evidence on the efficacy of (adeno)tonsillectomy from the trials.…”

Study of the Effects of 736 Tonsillectomies and of 741 Controls

“…The conditions should not be considered as contraindications for tonsillectomy, with the exception of cases of pulmonary tuberculosis which must be very carefully studied before operation is decided upon. 6. Complaints in the control group of cases do not show any improvement during the period of one year of observation as compared with 91 per cent of improvement shown in the group of cases operated on.…”