Peritonsiler abscess (PTA / Quinsy) 9

COMPLICATIONS
Complications that can arise in the abscess is peritonsiler (Fachruddin, 2002):
1. Spontaneous abscess rupture, causing hemorrhage, or pulmonary aspiration pyernia.
2. Spreading infection and abscess to the area, causing parafaring abscess parafaring.
3. If there is spreading to the region may lead to intracranial sinus thrombus Cavemosus, meningitis and brain abscess.
4. Nephritis, peritonitis, mediastinitis.

PROGNOSIS
Most of the patients treated with antibiotics and adequate drainage in the area will return abscces recover within a few days. A small percentage of complaints indicates a further abscess, and it is necessary tonsilektomi action. In addition, if the patient reported back pain throat complaints that persist after incision and drainage is appropriate, action may be indicated tonsilektomi (Gosselin, 2008).

CONCLUSION
1. Peritonsiler abscess (PTA) is an infection that occurred in the area - the area around tonsila Palatina caused by aerobic and anaerobic bacteria.
2. Pathophysiology of PTA is certainly not known, but one thing is widely agreed that the occurrence of an abscess is associated with inflammation of the tonsils previous events.
3. Management is done in cases of abscess peritonsiler with adequate antibiotics when the stadium infiltrates. Arise when the abscess is incision and should be followed by drainage tonsilektomi action.
4. Complications that can arise due to inadequate handling and complete. As if there is an appropriate treatment, the prognosis would be good then.

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Peritonsiler abscess (PTA / Quinsy) 8

Management
Handling peritonsiler abscess include hydration, pain, and antibiotics are effective to overcome Staphylococcus aureus and anaerobic bacteria. Fine needle aspiration is an effective treatment in 75% peritonsiler abscess in children and is recommended as primary therapy unless there is a history of recurrent tonsillitis, or abscess before it peritonsiler measure is immediately tonsilektomi (Bailey, 2005).
In the infiltration stage, given high doses of antibiotics, and symptomatic medications. Also need to gargle-gargle with warm water and cold compresses on the neck. Appropriate choice of antibiotic depends on the results of cultures of microorganisms in the needle aspiration. Penicillin is a "drug of choice" in peritonsilar abscesses and 98% effective in cases when the combicated with metronidazole. Dosage for penicillin in adults is 600 mg IV every 6 hours for 12-24 hours, and children 12500-25000 U / kg every 6 hours.
Initial dose metronidazole for adult maintenance dose of 15mg/kg and 6 hours after initial dose with intravenous 7.5 mg / kg for 1 hour was given for 6-8 hours and not exceed 4 grams / day (Fachruddin, 2002).
If formed abscess, requiring surgical drainage, either by needle aspiration technique or with incision and drainage techniques. Difficulties may arise in ascertaining whether associated with acute cellulitis or abscess formation which had actually been hesitant happen, needle size 17 can be inserted (after application with anesthetic spray) into the three locations that seemed most likely to produce pus aspirations. If pus is found by accident, this method may be sufficient for drainage followed by antibiotics. If the amount of pus were found, and insufficient drainage with this method, a further incision and drainage can be done (Adams, 1997).
Incision and drainage technique requires local anesthesia. First pharynx sprayed with topical anesthetic. Then 2 cc Xilocain with adrenaline 1 / 100, 000 injected. Knife tonsila no 12 or no 11 with tape to prevent deep penetration used to make the incision through the mucosa and submucosal polar near the tonsilaris fossa. Place of incision is the most prominent areas and soft or in the middle of the line joining the base of uvula with the last molar on the side of dull aching Hemostat is inserted through the incision and gently stretched. Tonsila suction should be provided to collect pus issued. In older children or young adults with severe trismus, surgical drainage for abscesses peritonsiler possible after the application of fluid cocaine 4% in the incision area and regional areas and the fossa ganglion sfenopalatina Nasalis. This is sometimes reduce pain and trismus. Children younger require general anesthesia. Tonsilektomi recommends immediate (tonsilektomi quinsy) feel that this is a safe procedure that helps perfect drainage of the abscess if tonsila removed (Adams, 1997).
When tonsilektomi performed with acts of abscesses drainage tonsilektomi it is called "a chaud", when tonsilektomi performed 3-4 days after darinase abscess tonsilektomi called "a tiede" and if tonsilektomi performed 4-6 weeks after the drainage of abscesses tonsilektomi called "a froid ". Tonsilektomi generally performed after the infection quiet, ie 2-3 weeks after the drainage of abscesses (Fachruddin, 2002).
If there is trismus, then to overcome the pain, given analgesia (local), with novocain injected xylocain or 1% of ganglion sfenopalatinum. This ganglion is located at the rear of the lateral from concha media. Sfenopalatinum ganglion nerve has branches Palatina anterior and posterior media that send branches to aferen nerve tonsil and palate molle on the tonsils. The most appropriate area for the incision got inervasi from Palatine branch m. trigeminal ganglion sfenopalatinum passing. Then the patients recommended for surgery tonsilektomi (Fachruddin, 2002).
Tonsilektomi an absolute indication to people who suffer from recurrent abscess or abscess peritonsilaris which extends to the surrounding tissue. Peritonsil abscess has a large tendency to relapse. Until now there has been no agreement on when tonsilektomi done peritonsil abscess. Some authors recommend 6-8 weeks later tonsilektomi considering the possibility of bleeding or sepsis, whereas others recommend immediate tonsilektomi (Adams, 1997).

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Peritonsiler abscess (PTA / Quinsy) 7

DIAGNOSIS
Information from patients is needed to make the diagnosis peritonsiler abscess. Patients had a history of pain in the esophagus is one that supports peritonsilar abscess. History of acute pharyngitis and tonsillitis accompanied by a lack of comfort in unilateral pharingeal (Steyer, 2007).
The diagnosis is rarely in doubt if the inspector saw a large swelling peritonsilaris, pushing past the midline uvula, with edema of the palate molle and protrusion of tissue from the midline. Palpation if possible to distinguish abscess from cellulitis (Adams, 1997).
In the investigation can be done:
1. Laboratory tests such as complete blood, electrolytes, and blood culture. Which is the "gold standard" for diagnosing abscess peritonsilar is by collecting pus from the abscess using a needle aspiration (Jevuska, 2007).
2. Radiological examination in anteroposterior position only shows "distortion" of the network but not useful for certain locations who abscess (Daley, 2007).
3. On CT scan can be seen on the tonsils hipodens areas that indicate the presence of fluid in the affected tonsils besides that it also can be seen in an asymmetrical enlargement of the tonsils. This examination can help to plan the operation (Daley, 2007).
4. Ultrasound, a technique is simple and noninvasive and can help in distinguishing between cellulitis and the beginning of the abscess. This examination can also determine a more focused selection before surgery and drainage for sure.

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Peritonsiler abscess (PTA / Quinsy) 6

Typically, complaints emerged in patients with a history of acute pharyngitis with acute tonsillitis (Gosselin, 2008). Classic symptoms begin 3-5 days time from onset of symptoms until the occurrence of abscesses around 2-8 days. Patients usually experience odinofagia complaints (pain swallowing) is good, so difficult to do tests because it is difficult to open his mouth and dehydration can also occur, vomiting (regurgitation), halitosis (foeter ex ore), "hot potato voice", a lot of saliva (hipersalivasi), nasal voice (rinolalia) and difficult to open the mouth (trismus), headache, weakness, fever, and swollen glands submandibula with tenderness. Patients also may experience pain when moving the neck (Fachruddin, 2002).
Some patients also have ipsilateral otalgia during swallowing. Trismus, which appears on all of the cases of several degrees of severity, suggesting an inflammation of the lateral wall of the pharynx and muscle pterigoid. Because inflammation of the muscles and cervical lymphadenopathy, sometimes patients also complain of neck pain and limited neck motion. The doctors should be more wary of the PTA, when seeing patients with symptoms of inflammation of the pharynx that persist despite antibiotics have been given adequate preparation (Gosselin, 2008).
On physical examination can be found in various conditions, from acute tonsillitis with unilateral asymmetric pharynx until the occurrence of dehydration and sepsis. Used by most patients experiencing tremendous pain. Oral examination will find eritem mucosa, palate, mole appeared swollen and prominent in the future, may be felt fluctuations. Uvula swollen and pushed to the contralateral side. Swollen tonsils, hiperemis, maybe a lot of detritus and pushed toward the center, front, and bottom (Fachruddin, 2002).

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Peritonsiler abscess (PTA / Quinsy) 5

Peritonsiler abscess is an infection that started from the outer surface that extends into the inner layer of soft tissue. Exactly pathophysiology of PTA is unknown. However, several theories attempt to explain the mechanism of the PTA, and the theory was widely accepted that the occurrence of an abscess peritonsiler tonsil inflammation spreading from there. Abscess formed between tonsila Palatina and the capsule, usually in the superior region. It is then believed that the abscesses originated from an acute episode include tonsilits growing soft tissue around the area (Mehta, 2007). Other Mecanisme happened is the emergence of necrosis and pus in the capsular area, which then clog the Weber glands, minor salivary glands found in the living and working peritonsiler help clean up debris from the tonsils, resulting in secretions and forming abscesses (Gosselin, 2008).
Superior and lateral regions tonsilaris fossa is loose connective tissue, the infiltration into the potential supurasi posters peritonsil occupy this area, so look swollen palate molle. In the early stage (stage infiltrates), in addition to swelling, the surface looks hiperemis. If the process continues, the area is more soft and yellowish color. Tonsils pushed to the middle, front and bottom, and swollen uvula pushed to the contralateral side. If the process continues, inflammation of the surrounding tissue will cause irritation of the m. Pterigoid internal, resulting in trismus. Abscesses may rupture spontaneously, may occur to the pulmonary aspiration (Fachruddin, 2002).

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Peritonsiler abscess (PTA / Quinsy) 4

Some microorganisms that can cause acute or chronic tonsillitis can also be a PTA-causing organisms. Aetiology peritonsiler abscess most frequently encountered is a species of aerobic and anaerobic gram-positive are usually found in the culture, usually bacterial beta-hemolytic Streptococcus group A. The next most common is from Staphilokokus groups, pneumococcal, and Haemophilus. And other microorganisms that can be found in the culture including Laktobasillus, groups such as filamentosa shaped Actinomyces sp., Mikrokokus, Neisseria sp., Diphtheria bacteria, Bacteroides sp., And some bacteria other non-sporulation (Gosselin, 2008). Sometimes the infection continues to be tonsila cellulitis difusa of the palate extends tonsila mole. Continuation of this process causes abscesses peritonsilaris. These disorders can occur quickly, with the beginning of tonsillitis, or the end of the course of the disease of acute tonsillitis. This can happen even if given penicillin. Usually unilateral and more frequently in children older and younger adults (Adams, 1997).

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Peritonsiler abscess (PTA / Quinsy) 3

Pharynx is divided into nasopharynx, orofaring and laringofaring. Nasopharynx is part of the pharynx that lies above pallatum molle, which is part orofaring located between palate molle and hyoid bone, while laringofaring part of the pharynx which extends from the hyoid bone to the lower boundary of cartilage crikoid (Ballenger, 1997). Orofaring open to the oral cavity in the anterior pharyngeal pillars. Pallatum molle (vellum palati) consists of muscle fibers are supported by fibrous tissue which is covered by mucosa. Protrusion on the median dividing it into two parts. Forms such as cones, located disentral called uvula. Two columns made up of tonsils tonsilar Palatina anterior and posterior. Glossoplatina and pharyngopalatina muscle is the largest muscle that make up the pillars of the anterior and posterior columns. Tonsils located between the basin palatoglossal and palatopharyngeal (Steyer, 2007).
Plika triangularis (tonsilaris) is a thin fold of mucosa, which covered the anterior pillar and some and some anterior surface of the tonsils. Plika semilunaris (supratonsil) is the upper folds of the mucosa which unites the two pillars. Supra tonsil fossa is the size of the gap varies over the tonsils, located between the anterior and posterior pillars. Tonsil consists of a protrusion of the circular or circular like cripte containing lymphoid tissue and surrounding connective tissue there. Amid the estuary there cripta mucous glands (Ballenger, 1997).
Tonsils and adenoid are the most important part of the Waldeyer ring lymphoid tissue surrounding the pharynx. Tonsils are located in the sinuses tonsilaris between the anterior and posterior pillars faussium. Faussium tonsils are one on each side is orofaring lymphoid tissue that is wrapped by a clear fibrous capsule. The inner surface of the membrane covered by stratified squamous epithelium which is attached. This epithelium extends into the open surface kripta tonsils. Kripta numbered 8-20 on the tonsils, usually tubular and is almost always extends from the tonsils to kekapsul the outer surface of the tonsils. The bound m.konstriktor faringeus superior, so depressed every time swallowing. m. palatoglusus and m. palatofaring also pressing the tonsils.
During the embryonic period, tonsils pharyngeal pouch formed from the second sebegai endodermal bud from the cell. Shortly after birth, tonsils are irregular and grow until it reaches the size and shape, depending on the number of network limphoid (Steyer, 2007).
Structure around tonsilla Palatina (Jevuska, 2007):
1. Anterior
In the anterior part is tonsilla Palatina palatoglossus Arcus, can extend for a short distance below it.
2. Posterior
There posteriorly palatopharyngeus Arcus.
3. Superior
In the superior near palate molle. Here tonsilla joined the lymphoid tissue on the lower surface of palate molle.
4. Inferior
In a third of the posterior inferior tongue. Here, together with tonsilla Palatina tonsilla lingualis.
5. Medial
In the medial part of the oropharynx space.
6. Lateral
There lateral capsula separated from the superior m.constristor pharyngis by loose areolar tissue. V. Palatina externa walked down from the palate molle in this loose connective tissue, to join the plexus venosus pharyngeus. Lateral to the superior pharynges there m.constrictor m. styloglossus and a.facialis arch. A. The internal carotid is located 2.5 cm behind and lateral tonsilla.
Palatina Tonsilla get vascularisasi from: tonsillaris ramus which is a branch of the facialis artery; the branches of a. Lingualis; a. Palatina ascendens; a. Pharyngea ascendens. While innervasinya, obtained from N. Palatinus Glossopharyngeus and minor nerve. Lymph vessels in the nl. Cervicales profundi. The most important node in this group are jugulodigastricus node, which lies below and belakangangulus mandibulae.

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Peritonsiler abscess (PTA / Quinsy) 2

Peritonsiler abscess (PTA) is the infectious disease most often occurs in the head and neck. A combination of aerobic and anaerobic bacteria in the peritonsilar area. Which could potentially place the abscess is a pillar area tonsils anteroposterior, inferior Piriform fossa, and superior palate (Mehta, 2007).
According to Gosselin (2008), peritonsiler abscess (PTA) is a pile of pus that is localized on the peritonsiler network formed as a continuation of supuratif tonsillitis. The alternative explanation that the PTA is an abscess that is formed from a group of salivary gland in supratonsiler fossa, known as the Weber glands. Because composed of loose connective tissue, severe infections in these areas can quickly lead to purulent material.
Peritonsil abscess formed due to the spread of infectious bacterial organisms to one's throat loose aereolar room around the pharynx causing abscess formation, where the infection has penetrated tonsil capsule but remains within the limits of pharyngeal constrictor muscle.

Epidemiology
Peritonsiler abscesses can occur at the age of 10-60 years, but most often occurs at the age of 20-40 years. In children is rare except in those who decreased immun system, but the infection can cause airway obstruction is significant in children (Mehta, 2007). These infections have the same proportion of men and women. Evidence indicates that chronic tonsillitis or multiple experiments using oral antibiotics for acute tonsillitis predispose people to develop peritonsiler abscess. In America sometimes incident -
sometimes approximately 30 cases per 100,000 people per year, are considered almost 45,000 cases each year (Gosselin, 2008).

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Peritonsiler abscess (PTA / Quinsy) 1

Recent years diagnosis and treatment of infection in the neck has been given the challenge to the experts to do more research. The complexity and depth of the location in this region makes difficult the diagnosis and treatment is established.
Neck abscess formed in the potential space between the fascia in the neck as a result of infection spreading from various sources, such as teeth, mouth, throat, paranasal sinuses, middle ear and neck which depends on space involved. Clinical signs and symptoms may include pain and swelling. Peritonsiler abscess (PTA / Quinsy) is one of the neck abscess in which besides the neck abscess abscess can also retrofaring, parafaring abscesses, abscesses and angina submandibula Louis (Ludwig angina) (Fachruddin, 2002).
Peritonsiler abscess is usually a complication of acute tonsillitis cases. The presence of inflammation in the form of edema can be a major cause of complaint difficult in swallowing. Dehydration often appear in advanced stage patients who refused to eat and drink because of the pain he felt. The expansion of these abscesses can cause inflammation that is felt until the entire face and neck, and the possibility it may cause airway obstruction (Gosselin, 2008).

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how to choose baby's sex? conclusions

In the present and future periods is the ideal small family and the good boys and girls alike. But we can still find a husband who left his wife because his wife could not born child of the desired gender, or still often we see a husband and wife will not stop reproducing, despite being the umpteenth child was born, because the gender of the coveted yet come. Eventually will make a great family.

Since ancient times many myths have emerged that indicate the existence of demand for some people to have children with a specific gender. Existing demand and speculation about what gender to be born. That's how myths are formed. Not to mention the myths about ways to get a boy or girl of that sounds reasonable until the no. For example, to get the girl, the mother should eat a lot of sweets. This is certainly contrary to the doctor ordered, since sweet foods may trigger the emergence of diseases such as diabetes and hypertension.

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how to choose baby's sex? CHOOSING BUSINESS AS baby's sex date

Some researchers such as Gordon, M., Bhattacharja, BC and Leiberman, E.J. try to separate the two populations of sperm and andro-sperm-sperm gino genuine. Then this pure seeds inserted into the uterine insemination by wives. Thus the certainty will be obtained by birth desired gender.
A. Electrophoresis methods
The rationale is that andro and gino-sperm have masses, sizes and different shapes. Will therefore contain an electrical load or different poles. So in this way are expected to andro-sperm will be attracted and gathered at one pole while gino-sperm into the other pole (Mochtar, 1998).
B. Centrifugation method (Pemusingan)
Since weight and mass are different, then after the two kinds of sperm sentrifuse each will form a layer in the tube, the layer containing the sperm and andro-containing layer gino-sperm (Mochtar, 1998).
C. Sedimentation methods (Sedimentation)
By the influence of gravity, gino greater sperm more quickly settles to the bottom of the tube deposits, while andro-more sperm live in the top layer (Mochtar, 1998).
D. Diaphragm method (Filter)
This method using a special diaphragm which just missed, such as andro-sperm and sperm contain-gino. The diaphragm is mounted close the cervix uteri of women like the only contraceptive diaphragm (Mochtar, 1998).
E. Pills Men and Women Pill
Researchers predict that within the next 2-3 decades advances in science in the field of biomedicine will produce a pill that can determine the sex. This pill will be swallowed by the husband prior to intercourse. If a woman wants a baby girl swallow pills. This was stated by Brich, CH. Director of Biology University of Sidney (Mochtar, 1998).
F. Reaction Tube Method
By using the tools that complicated and expensive researchers like Gardner, R., Edward, R., and Hafes, ESE. have been able to choose sperm and egg cells are guaranteed good quality. Similarly, through the micro operations, the embryo was able manipulated. Even they can separate the sex-chromatin found only in female cells only (Mochtar, 1998).
From developed countries reported that many are now available ready-made sperm, egg cells (ova), and even embryos stored in a sperm bank, the bank ova, and embryo banks.
The events of the amazing scientific disciplines of biology in humans has been much publicized. Among other things, the progress of science has been able to help many women who are naturally according to science content will not be able to have offspring because of the total damage to both the oviduct (fallopian tubes). How to help this woman popularly called "test-tube babies" which in principle is to perform the technique in vitro fertilization (IVF), fertilization is a technique in the tube containing food (tube nurseries), followed Embryo Transfer (ET), is the result seedbeds that implanted into the womb (Mochtar, 1998).
G. Cloning Method
Gender identification method days to be very amazing. But from a moral standpoint and spiritual will have broad impact.
The way is called cloning, which comes from the Greek word meaning a way / means of propagation without sexual relations. According to experts, not only allow cloning choose sex, but can also produce genetic clone (copy) which is identical to the original (Mochtar, 1998).
H. Method Preimplantation genetic diagnosis (PGD) by Leigh (2005), among others:
Is a technique fertiliasi in vitro (IVF) in which embryos created outside the womb and then tested gender and genetic disorders.
When PGD was introduced in 1989, this technique is only used to help couples or someone with a serious genetic disorder that reduces the risk of having offspring that suffer from the same disorder. PGD is now used for the same reasons but also used in women age 35 years or older and or have a history of abortion habitualis. Only the expert clinicians with this technique that can use this technique to select the sex without a medical reason. This technique has almost 100% effectiveness
During the IVF cycle, egg fertilized with sperm in a petri dish. Single cell or several cells into embryos and then moved 3 to 5 days and tested gender.
In normal IVF cycle, the researchers tried to distinguish between normal embryos by looking under the microscope. But with PGD, embryos are tested thoroughly genetic disorders and gender. By transferring only healthy embryos into the uterus, there would be little possibility of abortion or having children with genetic disorders. Prenatal tests such as amniocentesis or chorionic villus sampling (CVS) was recommended if a woman aged 35 years or more because of genetic abnormalities can be detected in the older age pregnancy.
In normal IVF cycle, doctors usually transfer two or more embryos into the uterus. The amount depends on maternal age, embryo quality, and reproductive history. But with PGD, doctors transfer only no more than two because the embryos implant or may not result in a healthy pregnancy is removed.
I. Microsort method
Dye technique is a technique that tries to separate the sperm women with male sperm. Sperm with the desired gender are inserted directly into the uterus, usually through artificial insemination (AI) (Leigh, 2005).
Based Microsort that female sperm carrying the X chromosome is larger than female sperm carrying Y chromosomes This procedure involves staining sperm samples dipped in fluorescent and then eliminate them with lasers. X chromosome absorbs more dye and shine brighter than the Y chromosomes Sperm are then selected with the desired sex are transferred to the uterus by using artificial insemination. In the same case, in vitro fertilization (IVF) can be used to increase the possibility of pregnancy but very invasive and expensive (Leigh, 2005).
J. Ericsson Method
Is a technique that aims to separate the male sperm with female sperm. Sperm with the desired gender is inserted directly into the uterus through artificial insemination (Leigh, 2005).
Technique Ericsson has the effectiveness of 78-85% for sex selection of men and 73 to 75% for female sex selection (Leigh 2005).
Whole sperm swim, but the male sperm swim faster and reach the bottom. Rapid sperm swimming with the slow and sperm separated by the desired gender inseminased (Leigh, 2005).

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