RESUMEN
OBJECTIVE: To describe a case of Burkitt lymphoma (BL) in a child manifesting with acute airway obstruction. To review available literature on the clinical features and characteristic presentation of this disease. METHODS: Case report with literature review. RESULTS: We present the case of an 8-year-old boy with nasopharyngeal BL manifesting initially as sore throat, nasal congestion, and snoring that progressed to dyspnea and, ultimately, acute airway obstruction requiring emergent tracheostomy. The child was treated with intensive chemotherapy and achieved complete response. CONCLUSION: This case highlights the importance of maintaining high clinical suspicion when evaluating common otolaryngologic symptoms and emphasizes the potential for Burkitt lymphoma to cause rapid patient deterioration.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/tratamiento farmacológico , Neoplasias Nasofaríngeas/complicaciones , Neoplasias Nasofaríngeas/tratamiento farmacológico , Traqueostomía/métodos , Enfermedad Aguda , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/diagnóstico por imagen , Niño , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Disnea/diagnóstico por imagen , Disnea/etiología , Disnea/cirugía , Detección Precoz del Cáncer , Urgencias Médicas , Humanos , Masculino , Metotrexato/administración & dosificación , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico por imagen , Tomografía de Emisión de Positrones , Prednisona/administración & dosificación , Rituximab/administración & dosificación , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vincristina/administración & dosificaciónRESUMEN
OBJECTIVES/HYPOTHESIS: To determine the rate and predictors of receiving multiple tympanostomy tube (TT) placements in children. STUDY DESIGN: Systematic review and meta-analysis. METHODS: PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting the risk factors for receiving repeat TT (r-TT) placements in children with chronic otitis media with effusion or recurrent acute otitis media. These articles were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Data were pooled using a random-effects model. RESULTS: Twenty-one studies involving a total of 290,897 children were included. Among all patients, 24.1% (95% confidence interval (CI), 18.2%-29.9%) underwent ≥2 TT placements and 7.5% (95% CI, 5.7%-9.4%) underwent ≥3 TT placements. Craniofacial disease (odds ratio (OR) 5.13, 95% CI, 1.57-16.74) was the strongest predictor of r-TT. Younger age at initial TT placement and shorter TT retention time were also significantly associated with r-TT. Receipt of primary adenoidectomy with initial TT placement was associated with decreased odds of r-TT (OR, 0.46; 95% CI, 0.39-0.55). Long-term tubes also significantly reduced the odds of r-TT (OR, 0.27; 95% CI, 0.17-0.44). CONCLUSIONS: About 1 in 4 children receiving TT will receive at least one repeat set of TT and about 1 in 14 will receive multiple repeat sets. Concurrent adenoidectomy and long-term tubes reduced the incidence of r-TT. Younger patients and those with earlier extrusion of the initial set are at increased risk for repeat surgery. The identification of these risk factors may improve parental counseling and identify patients who might benefit from closer follow-up. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2363-E2370, 2021.
Asunto(s)
Adenoidectomía/estadística & datos numéricos , Remoción de Dispositivos/estadística & datos numéricos , Ventilación del Oído Medio/estadística & datos numéricos , Otitis Media/cirugía , Reoperación/estadística & datos numéricos , Cuidados Posteriores , Niño , Enfermedad Crónica/terapia , Humanos , Ventilación del Oído Medio/instrumentación , Factores Protectores , Recurrencia , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: Recommendations for polysomnography (PSG) in pediatric sleep disordered breathing (SDB) vary between the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the American Academy of Pediatrics (AAP). We determined the rates of preoperative PSG in children without risk factors outlined in the AAO-HNS Clinical Practice Guidelines and described the postoperative course of those patients following T&A. METHODS: Patients aged 3-17 undergoing T&A for SDB or OSA who did not have an indication for preoperative PSG were included. We conducted retrospective review to describe the rate, type, and timing of respiratory complications for patients with and without PSG following T&A, and discuss cases where disposition was changed due to PSG results. RESULTS: 1135 patients without risk factors underwent T&A for SDB or OSA. 196 (17%) had a preoperative PSG, of whom 85 (43.3%) had AHI >10 and 38 (24.8%) had an O2 nadir <80%. 69 (85%) patients with PSG-diagnosed severe OSA were admitted overnight. Of the entire cohort, 5 patients (0.44%) had hypoxemia requiring blow-by oxygen or repositioning. 4 (0.43%) patients without PSG experienced respiratory events and were converted to overnight stay. The timing of respiratory events for all children ranged from immediately following extubation in the operating room to 3 h postoperatively. CONCLUSION: PSG in children without risk factors results in admission of otherwise healthy patients following T&A who would have otherwise undergone ambulatory surgery. PSG alone in pediatric patients with no AAO-HNS risk factors should not influence postoperative disposition. These patients should be monitored for 3 h post-T&A and discharged in the absence of complications. EVIDENCE LEVEL: 2b.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Apnea Obstructiva del Sueño/cirugía , Tonsilectomía/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Monitoreo Fisiológico , Polisomnografía , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/diagnósticoRESUMEN
Importance: Pediatric tracheostomy is commonly performed for upper airway obstruction and prolonged mechanical ventilation. Children undergoing tracheostomy typically have multiple chronic medical problems that place them at high risk for readmission and additional complications. Objective: To determine whether the institution of a postoperative protocol for parent education and wound care with a nurse trained in tracheostomy care decreases the rate of readmission and other complications. Design, Setting, and Participants: A case series and medical record review was conducted of children 18 years and younger who underwent tracheostomy at a tertiary pediatric medical center between January 1, 2009, and December 31, 2014. Intervention: A postoperative tracheostomy care and education protocol. Main Outcomes and Measures: Overall 30-day readmission rate, 30-day tracheostomy-related readmission rate, tracheostomy wound complications, and additional factors that may have affected readmission rates and wound complications (age at the time of tracheostomy, discharge location, indication for tracheostomy). Results: A total of 191 children (118 boys and 73 girls) were included; of these, 112 participated in the education protocol and 79 children did not. Following institution of the education protocol, there was no decrease in the overall readmission rate (26.8% before the protocol vs 26.6% after the protocol; difference, 0.2%; 95% CI, -12.5% to 13.0%) or in the tracheostomy-related readmission rate (10.1% before the protocol vs 7.1% after the protocol; difference, 3.0%; 95% CI, -5.0% to 11.0%). Overall, 68.6% of readmissions were associated with medical comorbidities (95% CI, 55.9% to 81.3%). There was a significant decrease in tracheostomy-related wound complications after institution of the protocol (31.6% to 17.9%; difference, 13.7%; 95% CI, 1.6% to 26.0%). Multiple logistic regression analysis showed that children who were discharged home were significantly more likely to be readmitted for a tracheostomy-related complication than were patients discharged to an advanced care facility (odds ratio, 14.47; 95% CI, 3.08 to 67.92). Conclusions and Relevance: Tracheostomy care requires expertise for all caregivers and is challenging for people without specialized training. Specialized nursing and education protocols are associated with decreased complications of tracheostomy wounds. Children who are discharged directly to home are at higher risk for readmission compared with children discharged to advanced care facilities. Further development of caregiver education protocols is necessary to continue to reduce readmissions and tracheostomy-related complications.
Asunto(s)
Padres/educación , Complicaciones Posoperatorias/prevención & control , Traqueostomía , Femenino , Humanos , Modelos Logísticos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Cuidados Posoperatorios , Estudios Retrospectivos , Herida Quirúrgica/complicaciones , Infección de la Herida QuirúrgicaRESUMEN
Desmoid fibromatosis, or aggressive fibromatosis, is a benign but locally infiltrative fibroblastic neoplasm arising from fascial or musculoaponeurotic tissues. Although lacking metastatic potential, head and neck fibromatosis can have significant functional or cosmetic morbidities. 7%-15% of all desmoid tumors are seen in the head and neck region, 57% of which occur in the pediatric population. The incidence of pediatric desmoid tumor peaks around age 8. Treatment of choice is complete surgical resection; however, local recurrence is common. We present a case of a 14-month-old male with an 8-cm desmoid tumor in the right parapharyngeal space and provide an overview of diagnosis and management of pediatric head and neck fibromatosis. This is the largest desmoid tumor of the parapharyngeal space in the youngest patient described in the literature.
Asunto(s)
Fibromatosis Agresiva/diagnóstico , Fibromatosis Agresiva/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Lactante , MasculinoRESUMEN
INTRODUCTION: Children surviving a strangulation event are unique from adults in that they are at risk for significant airway compromise due to the smaller relative size of their airways. To date, no study has specifically evaluated the laryngeal findings and management of pediatric near-hanging patients. METHODS: A retrospective chart review was performed on all near-hangings presenting to the a tertiary care children's hospital from January 2001 until June 2010. Demographic information was compiled in addition to laryngeal findings. RESULTS: Sixteen children were identified. Four had a documented laryngeal injury, one of which was a major injury requiring a tracheotomy. CONCLUSION: Laryngeal examination should be standard of care for any child presenting after a near-hanging event.
Asunto(s)
Manejo de la Vía Aérea/métodos , Asfixia/terapia , Laringe/lesiones , Traumatismos del Cuello/terapia , Intento de Suicidio , Tráquea/lesiones , Heridas no Penetrantes/terapia , Accidentes Domésticos , Adolescente , Factores de Edad , Asfixia/diagnóstico , Asfixia/etiología , Niño , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Traumatismos del Cuello/complicaciones , Traumatismos del Cuello/diagnóstico , Estudios Retrospectivos , Tasa de Supervivencia , Heridas no Penetrantes/diagnósticoRESUMEN
OBJECTIVE: To show that sialoendoscopy is both a safe and effective alternative to traditional treatments for juvenile recurrent parotitis and sialolithiasis. DESIGN: Retrospective medical chart review. SETTING: Two major pediatric tertiary care centers. PATIENTS: Eighteen pediatric patients. INTERVENTIONS: A total of 33 sialendoscopic procedures on 27 glands. MAIN OUTCOME MEASURES: Indications for surgery, age at onset of symptoms, age at procedure, sex, intraoperative findings, complications, recurrences, need for additional procedures, and follow-up interval. RESULTS: Juvenile recurrent parotitis was the most common indication for sialendoscopy (12 of 18) followed by sialolithiasis (4 of 18). Ten of 12 patients with juvenile recurrent parotitis were asymptomatic after 1 or 2 sialendoscopies (8 patients and 2 patients, respectively). There were 6 minor complications. Three patients ultimately required gland excision for disease management. CONCLUSION: Sialoendscopy is safe and effective as a treatment for pediatric salivary gland disorders.
Asunto(s)
Endoscopía/métodos , Parotiditis/cirugía , Cálculos de las Glándulas Salivales/cirugía , Adolescente , Niño , Femenino , Humanos , Masculino , Parotiditis/diagnóstico , Cálculos de las Glándulas Salivales/complicacionesRESUMEN
BACKGROUND: Neck trauma in the pediatric population is relatively rare with limited discussion in the literature describing the injury patterns and outcomes of all neck trauma victims. This study characterizes pediatric neck trauma both inside and outside the context of injuries requiring otolaryngology (ENT) intervention. METHODS: Patients sustaining neck trauma presenting to a single tertiary care hospital between January 2001 and June 2010 were included. Demographic information was obtained in addition to information regarding the initial hospital stay and follow up visits related to the initial trauma. RESULTS: Seventy-four patients were included. Blunt injuries were found in 44 children with 30 sustaining penetrating injuries. Twenty-eight percent of patients had an ENT consultation. Those patients with injuries warranting ENT consultation were nearly 3 times more likely to require intubation than those without an ENT consultation (p=0.009). Laryngotracheal injuries were documented in 11 patients with 6 of these characterized as major injuries and 5 minor injuries. CONCLUSION: Pediatric neck trauma represents a spectrum of injuries from ecchymosis to major laryngotracheal injury. Otolaryngology involvement is not necessary in all cases; however, one must be aware of the risk of laryngotracheal injury, particularly with blunt trauma and there should be a low threshold for Otolaryngology consultation and endoscopy.
Asunto(s)
Traumatismos del Cuello/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Heridas no Penetrantes/cirugía , Heridas Penetrantes/cirugía , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales Pediátricos , Humanos , Lactante , Puntaje de Gravedad del Traumatismo , Laringoscopía/métodos , Masculino , Traumatismos del Cuello/diagnóstico , Procedimientos Quirúrgicos Otorrinolaringológicos/efectos adversos , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Estados Unidos , Cicatrización de Heridas/fisiología , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/diagnósticoRESUMEN
Plasma amyloid beta protein (Abeta42) levels and late onset Alzheimer's disease (LOAD) have been linked to the same region on chromosome 10q. The PLAU gene within this region encodes urokinase-type plasminogen activator, which converts plasminogen to plasmin. Abeta aggregates induce PLAU expression thereby increasing plasmin, which degrades both aggregated and non-aggregated forms of Abeta. We evaluated single nucleotide polymorphisms (SNPs) in PLAU for association with Abeta42 and LOAD. PLAU SNP compound genotypes composed of haplotype pairs showed significant association with AD in three independent case-control series. PLAU SNP haplotypes associated significantly with plasma Abeta42 in 10 extended LOAD families. One of the SNPs analyzed was a missense C/T polymorphism in exon 6 of PLAU (PLAU_1=rs2227564), which causes a proline to leucine change (P141L). We analyzed PLAU_1 for association with AD in six case-control series and 24 extended LOAD families. The CT and TT PLAU_1 genotypes showed association (P=0.05) with an overall estimated odds ratio of 1.2 (1.0-1.5). The CT and TT genotypes of PLAU_1 were also associated with significant age-dependent elevation of plasma Abeta42 in 24 extended LOAD families (P=0.0006). In knockout mice lacking the PLAU gene, plasma--but not brain--Abeta42 as well as Abeta40 was significantly elevated, also in an age-dependent manner. The PLAU_1 associations were independent of the associations we found among plasma Abeta42, LOAD and variants in the IDE or VR22 region. These results provide strong evidence that PLAU or a nearby gene is involved in the development of LOAD. PLAU_1 is a plausible pathogenic mutation that could act by increasing Abeta42, but additional biological experiments are required to show this definitively.
Asunto(s)
Enfermedad de Alzheimer/metabolismo , Péptidos beta-Amiloides/metabolismo , Predisposición Genética a la Enfermedad , Fragmentos de Péptidos/metabolismo , Activador de Plasminógeno de Tipo Uroquinasa/metabolismo , Factores de Edad , Enfermedad de Alzheimer/genética , Animales , Encéfalo/metabolismo , Estudios de Casos y Controles , Cromosomas Humanos Par 10/genética , Humanos , Ratones , Ratones Noqueados , Linaje , Polimorfismo de Nucleótido Simple , Activador de Plasminógeno de Tipo Uroquinasa/genéticaRESUMEN
OBJECTIVES: The primary purpose of this study was to determine the temporal characteristics of aerodynamic segments in the normal speech of children and adults without cleft palate. A secondary objective was to determine the within-speaker variability of the segments. METHOD: Speakers consisted of 46 children aged 6 to 8 years, 41 older children aged 11 to 12 years, and 41 adults aged 18 to 37 years (total n = 128) who repeated the word "hamper" during continuous utterances. The pressure-flow method was used to determine the duration of six segments of the oral air pressure and nasal airflow pulses associated with the /mp/ sequence. Descriptive statistics, including coefficients of variation (COV), were computed for each segment as a function of age and sex of the speakers. Analysis of variance (ANOVA) procedures were used to determine the effects of age, sex, or both on the temporal variables. RESULTS: ANOVAs indicated statistically significant main effects (p <.008) for age on five of the six temporal measures and for sex on three of the six measures. Five of the six COVs were also statistically significant for age. There were no statistically significant interactions between speaker age and sex for any measure. CONCLUSIONS: The results indicate distinct patterns of timing for aerodynamic segments of speech produced by children and adults. Overall, adults exhibited less temporal variability than children. The generally longer and more variable segments produced by children suggest diagnostic and treatment implications relative to speakers with velopharyngeal dysfunction.