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When infection penetrates the tonsillar capsule and involves the surrounding tissues, peritonsillar cellulitis results Peritonsillar abscess and cellulitis present with severe sore throat, odynophagia, trismus, medial deviation of the soft palate and peritonsillar fold, and an abnormal muffled ( hot potato ) voice Following therapy, peritonsillar cellulitis usually either resolves over several days or evolves into peritonsillar abscess The existence of an abscess may be confirmed by aspirating pus from the peritonsillar fold just superior and medial to the upper pole of the tonsil A No 19 or No 21 needle should be passed medial to the molar and no deeper than 1 cm, because the internal carotid artery may lie more medially than its usual location and pass posterior and deep to the tonsillar fossa There is controversy regarding the three ways to treat a peritonsillar abscess: needle aspiration, incision and drainage, or tonsillectomy Some clinicians incise and drain the area and continue with parenteral antibiotics, whereas others aspirate only and monitor as an outpatient To drain the abscess and avoid recurrence, it may be appropriate to consider immediate tonsillectomy (quinsy tonsillectomy) About 10% of patients with peritonsillar abscess exhibit relative indications for tonsillectomy All three approaches are effective and have support in the literature Regardless of the method used, one must be sure the abscess is adequately treated, since complications such as extension to the retropharyngeal, deep neck, and posterior mediastinal spaces are possible Bacteria may also be aspirated into the lungs, resulting in pneumonia While there is controversy about whether a single abscess is sufficient indication for tonsillectomy, most would agree that patients with recurrent abscesses should have a tonsillectomy

The .NET Framework provides a number of type-safe generic collections, including the List<T>, Stack<T>, Queue<T>, and Dictionary<Tkey><Tvalue>. Generics allow the collection designer to create a single collection without regard for the type of object it will hold, but to allow the collection user to define, at compile time, which type the object will hold. This enlists the compiler in finding bugs; if you add an object of the wrong type to a collection, it will be found at compile time, not at runtime. You are free to create your own generic collection types as well. The .NET Framework provides a number of interfaces that collections must implement if they wish to act like the built-in collections (such as being iterated by a foreach loop). An indexer allows you to access or assign objects to and from a collection just as you do with an array (for example, myCollection[5] = "hello").

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Johnson RF et al The contemporary approach to diagnosis and management of peritonsillar abscess Curr Opin Otolaryngol Head Neck Surg 2005 Jun;13(3):157 60 [PMID: 15908813] Khayr W et al Management of peritonsillar abscess: needle aspiration versus incision and drainage versus tonsillectomy Am J Ther 2005 Jul Aug;12(4):344 50 [PMID: 16041198]

school or work, recurrent peritonsillar abscess, and chronic tonsillitis Tonsillectomy is not an entirely benign procedure The pros and cons of tonsillectomy need to be discussed with each prospective patient Postoperative bleeding occurs in 2 4% of cases and on rare occasions can lead to laryngospasm and airway obstruction Pain may be considerable, especially in the adult Protracted emesis or fever may also occasionally occur Secondary bleeding 5 8 days postoperatively is far more common than bleeding in the first 24 hours There is increasing economic pressure for these procedures to be done as outpatient surgery At present it seems clear that outpatient tonsillectomy is usually safe when followed by a 6-hour period of uneventful observation, but individual circumstances may mandate hospitalization Although reports in the 1970s suggested an association of tonsillectomy with Hodgkin s disease, careful review of this literature reveals no conclusively causative association

Bhattacharyya N et al Economic benefit of tonsillectomy in adults with chronic tonsillitis Ann Otol Rhinol Laryngol 2002 Nov;111(11):983 8 [PMID: 12450171] Cattaneo C et al Oral cavity lymphomas in immunocompetent and human immunodeficiency virus infected patients Leuk Lymphoma 2005 Jan;46(1):77 81 [PMID: 15621784] Darrow DH et al Indications for tonsillectomy and adenoidectomy Laryngoscope 2002 Aug;112(8 Pt 2 Suppl 100): 6 10 [PMID: 12172229]

Indexers need not be restricted to integers. It is common to create indexers that take a string to assign or retrieve a value. All framework collections implement the Sort( ) method. If you want to be able to sort a collection of objects of a user-defined type, however, the defining class must implement the IComparable interface. The generic list collection, List<T>, works like an array whose size is increased dynamically as you add elements. The Queue<T> class is a first-in, first-out collection. The Stack<T> class is a last-in, first-out collection. A Dictionary<k,v> is a collection that associates a key with a value. Typically, the key is short and the value is large. You saw a handful of strings used in various places in this chapter, and you may wonder why we haven t discussed strings directly yet. That s because although strings can be used almost like any other primitive data type in their most basic form, the string class has a number of methods to it, so we deferred discussing them for a while. That s about to change, though; 15 is all about strings, and how to make them do what you want.

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