RESUMEN
OBJECTIVE: We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess. METHOD: Case report and review of the world literature. RESULTS: A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up. CONCLUSION: This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.
Asunto(s)
Absceso Epidural/complicaciones , Hipertensión Intracraneal/etiología , Infecciones Estreptocócicas/complicaciones , Enfermedad Aguda , Preescolar , Descompresión Quirúrgica , Duramadre , Absceso Epidural/microbiología , Absceso Epidural/terapia , Humanos , Hipertensión Intracraneal/terapia , Masculino , Apófisis Mastoides/cirugía , Otitis Media/etiología , Streptococcus pyogenes/aislamiento & purificación , Resultado del TratamientoRESUMEN
OBJECTIVE: To review the demographics, pathophysiology and management of aspiration of sharp, metallic foreign bodies; to review prevention strategies. DESIGN: Case series and review of the related literature (1932-2006). SETTING: Tertiary care pediatric hospital. PATIENTS: All patients presenting to BC Children's Hospital with aspiration of sharp, metallic foreign bodies since 1998. RESULTS: The seven patients ranged in age from 11 to 15 years (mean 13 years). The two boys had been playing with other boys at the time of aspiration. One aspirated a thumbtack and one aspirated a homemade blowdart (which traveled from his carina to his subglottis with coughing). Three of the five girls had been holding thumbtacks or a darting pin between their lips while putting up posters or sewing. The other two girls, who aspirated thumbtacks, refused to provide a history. One was treated successfully 6 days after the aspiration. The other girl withheld the history for over a year, presented with hemoptysis and eventually required thoractomy and right main bronchotomy to remove the tack. All of the other patients were diagnosed and successfully treated by rigid bronchoscopy within 24h. (Two patients initially had a failed attempt at foreign body removal by flexible bronchoscopy at another hospital.) This is the second largest series of aspiration of sharp, metallic foreign bodies since at least 1966. Adolescents are still aspirating sharp, metallic foreign bodies because of the same behaviors described by Jackson and Jackson in 1932. Education about choking hazards is needed for this age group. CONCLUSIONS: Aspiration of a sharp, metallic foreign body is a serious injury which is best treated by rigid bronchoscopy. These injuries potentially could be prevented through education.
Asunto(s)
Cuerpos Extraños , Metales , Aspiración Respiratoria , Sistema Respiratorio , Adolescente , Broncoscopía , Niño , Femenino , Cuerpos Extraños/prevención & control , Cuerpos Extraños/cirugía , Humanos , Masculino , Aspiración Respiratoria/fisiopatología , Aspiración Respiratoria/prevención & control , Aspiración Respiratoria/cirugía , Asunción de RiesgosRESUMEN
In patients with infectious mononucleosis (IM), acute tonsillectomy is advocated only in the minority who develop severe airway compromise. In such florid cases, the pathological diagnosis of IM, well known to morphologically simulate that of lymphoma, is particularly challenging. The present case describes a 15-year old male with a clinical course consistent with IM in whom acute tonsillectomy was performed due to progressive airway obstruction. The striking histological findings emphasize the need for close clinicopathological correlation. Recently available ancillary studies are described which both surgeon and pathologist should be familiar with in the differentiation of IM from other lymphoproliferative conditions.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Mononucleosis Infecciosa/microbiología , Linfoma/diagnóstico , Tonsilectomía , Adolescente , Obstrucción de las Vías Aéreas/cirugía , Bacterias Anaerobias , Diagnóstico Diferencial , Humanos , Mononucleosis Infecciosa/cirugía , MasculinoRESUMEN
BACKGROUND: Noninflammatory masses of the salivary gland region in children are extremely rare. Therefore, very few published individual and institution-based experiences exist. DESIGN: Retrospective chart review from 1990 through 1997. SETTING: University-based children's hospital. DESIGN: Patients 18 years of age or younger with a tumor in the salivary gland region. Masses of infectious origin were excluded. Hemangiomas and lymphangiomas were tallied for relative incidences only. RESULTS: Three hundred twenty-four consecutive cases of salivary gland masses were found: 192 hemangiomas (59.2%), 89 lymphangiomas (27.5%), and 43 (13.3%) solid masses. No significant difference was found between the age at presentation of the patients with benign solid tumors and the patients with malignant solid tumors (mean + SEM age, 7.2 + 0.7 years). Sixty-one percent of the masses were found in the parotid region; 18% were localized to the submandibular gland region; and the remaining 21% were located in a minor salivary gland site. The most common benign perisalivary masses were pilomatrixomas (20.9%), followed by pleomorphic adenomas (11.6%). The most common malignant masses were mucoepidermoid carcinomas (9.3%), followed by rhabdomyosarcomas (7.0%). Treatment was individualized to the disease. Twenty-two patients had adequate data for follow-up analysis (mean + SEM follow-up, 30.0 + 8.4 months). Four patients (18.2%) experienced recurrent or residual disease and were alive with disease at last follow-up, and 100% of our population demonstrated disease-specific survival at last follow-up. CONCLUSIONS: Vascular lesions outnumber solid tumors of the salivary gland region. The most common salivary tumors were pleomorphic adenomas, followed by mucoepidermoid carcinomas. Although certain solid salivary masses may demonstrate locally aggressive behavior, the overall prognosis is favorable. Arch Otolaryngol Head Neck Surg. 2000;126:1435-1439
Asunto(s)
Adenoma Pleomórfico/cirugía , Carcinoma Mucoepidermoide/cirugía , Hemangioma/cirugía , Linfangioma/cirugía , Pilomatrixoma/cirugía , Rabdomiosarcoma/cirugía , Neoplasias de las Glándulas Salivales/cirugía , Adenoma Pleomórfico/patología , Adolescente , Adulto , Factores de Edad , Carcinoma Mucoepidermoide/patología , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hemangioma/patología , Humanos , Lactante , Linfangioma/patología , Masculino , Glándula Parótida/patología , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugía , Pilomatrixoma/patología , Estudios Retrospectivos , Rabdomiosarcoma/patología , Neoplasias de las Glándulas Salivales/patología , Glándulas Salivales Menores/patología , Glándula Submandibular/patología , Neoplasias de la Glándula Submandibular/patología , Neoplasias de la Glándula Submandibular/cirugía , Factores de TiempoAsunto(s)
Fibromatosis Agresiva/diagnóstico , Fibromatosis Agresiva/terapia , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Preescolar , Fibromatosis Agresiva/genética , Neoplasias de Cabeza y Cuello/genética , Humanos , Imagen por Resonancia Magnética , Masculino , Mutación , Recurrencia Local de Neoplasia , Núcleo Familiar , Tomografía Computarizada por Rayos XRESUMEN
A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pediatric LTR and CTR. We propose strategies to prevent these infections. We also advocate the treatment of GERD during the healing phase of LTR.
Asunto(s)
Laringe/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Tráquea/cirugía , Bronquiolitis Viral/complicaciones , Bronquiolitis Viral/epidemiología , Bronquiolitis Viral/mortalidad , Displasia Broncopulmonar/complicaciones , Preescolar , Cartílago Cricoides/cirugía , Síndrome de Down/complicaciones , Femenino , Humanos , Recién Nacido , Laringoestenosis/cirugía , Laringe/anomalías , Masculino , Complicaciones Posoperatorias/mortalidad , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/epidemiología , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/mortalidad , Estudios Retrospectivos , Estaciones del Año , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/mortalidad , Tráquea/anomalías , Estenosis Traqueal/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: This study was conducted to assess the safety and efficacy of individualized management of congenital subglottic hemangioma (CSH) at the Children's Memorial Hospital in Chicago; describe treatment modalities, including endoscopic excision with the carbon dioxide (CO2) laser, systemic corticosteroids, and intralesional corticosteroid injection with short-term intubation; and determine the success of these various strategies in avoiding tracheotomy. METHODS: During the 10-year period between January 1, 1988 and December 31, 1997, 28 infants were diagnosed with CSH. A retrospective review of medical records was undertaken to determine demographics, presenting symptoms, location of the lesion, therapeutic modality, and complications. All patients were contacted at the time of writing. RESULTS: Twenty-eight patients met the criteria for this study. Gender distribution was 1.8:1 female to male. Age at diagnosis ranged from 4 weeks to 8 months, with a mean of 78.8 days and a median of 60 days. The location of CSH was most often posterior and on the left. Associated hemangiomas were found in 14 (50%) cases. The most common symptoms were stridor and cough. Management included 1 to 13 operative direct laryngoscopies and bronchoscopies, endoscopic excision with the (CO2) laser, and the use of systemic and intralesional corticosteroids. No patient required tracheotomy. CONCLUSION: Morbidity and the need for tracheotomy in CSH patients can be minimized using a combination of therapeutic modalities. Each infant's treatment is individualized based on the severity of the patient's symptoms and the morphology of the lesion.
Asunto(s)
Neoplasias de Cabeza y Cuello/terapia , Hemangioma Capilar/terapia , Femenino , Glotis/patología , Glucocorticoides/administración & dosificación , Neoplasias de Cabeza y Cuello/congénito , Hemangioma Capilar/congénito , Humanos , Lactante , Recién Nacido , Intubación , Terapia por Láser , Masculino , Estudios Retrospectivos , Traqueotomía , Resultado del TratamientoRESUMEN
OBJECTIVE: Gastroesophageal reflux (GER) has been shown, clinically and experimentally, to cause inflammation of traumatized laryngeal mucosa. This study was performed to determine if GER causes inflammation of untraumatized laryngeal mucosa. METHOD: Sixteen adult New Zealand white rabbits underwent tube pharyngostomy under general anaesthesia without endotracheal intubation. After 7 days recovery, 1 mL/kg of normal saline or HCl (pH 1.5) with pepsin (0.3 mg/mL) was infused into the piriform sinus while the rabbit was under mild sedation: once, twice, or three times per day, for 14 consecutive days. RESULTS: Rabbits that received HCl and pepsin exhibited various degrees of apnea and coughing. Eventually, most developed biphasic stridor on exertion. Histologically, the degree of laryngeal inflammation was greatest when GER was simulated three times per day. Glottic inflammation was greatest in one rabbit, which responded to GER simulation with paroxysmal coughing. CONCLUSION: The mechanism of injury in GER laryngitis is postulated to be a combination of chemical trauma (due to HCl and pepsin) and mechanical trauma (due to an individually variable laryngeal chemoreflex). Further study of GER laryngitis in this new animal model is warranted.
Asunto(s)
Reflujo Gastroesofágico/complicaciones , Laringitis/etiología , Animales , Femenino , Ácido Clorhídrico/metabolismo , Laringitis/metabolismo , Laringitis/patología , Masculino , Conejos , Distribución AleatoriaAsunto(s)
Hueso Etmoides , Mesenquimoma/congénito , Neoplasias Craneales/congénito , Craneotomía , Endoscopía , Hueso Etmoides/cirugía , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Mesenquimoma/cirugía , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Nariz/cirugía , Neoplasias Craneales/cirugíaRESUMEN
To assess the effect of endothelium-derived relaxing factor (EDRF) on diaphragmatic vascular resistance at rest and during contractions, we studied an in situ isolated diaphragm preparation in anesthetized and mechanically ventilated dogs. The arterial supply of the left diaphragm (phrenic artery) was catheterized and perfused with arterial blood at a fixed flow rate. Drugs were infused through a side port of the arterial catheter at 1/100th of the phrenic arterial flow. The inferior phrenic vein was catheterized to complete the isolation from the systemic circulation. Three sets of experiments were performed. In set 1 (n = 3), we infused endothelium-dependent (acetylcholine, ACh) and endothelium-independent (sodium nitroprusside, SNP) dilators at increasing concentrations. ACh and SNP infusion elicited a dose-dependent decline in phrenic vascular resistance (Rphr) at concentrations greater than 10(-8) M and 0.50 micrograms/ml, respectively. In set 2 (n = 15), we infused an inhibitor of EDRF synthesis and release, L-argininosuccinic acid (ArgSA), at increasing concentrations (10(-4), 3 x 10(-4), and 6 x 10(-4) M). ArgSA produced a dose-dependent increase in Rphr. Infusion of another EDRF inhibitor (NG-nitro-L-arginine, LNA, 6 x 10(-4) M) elicited increase in Rphr similar to that induced by ArgSA. In set 3 (n = 25), we infused ArgSA or LNA (6 x 10(-4) M) simultaneously with ACh and SNP and during sustained (2-Hz) contractions of the diaphragm. Both ArgSA and LNA completely reversed ACh vasodilation, whereas SNP vasodilation was reversed by 26 and 11%, respectively. ArgSA or LNA infusion during contractions reversed vasodilation by 48 and 52%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)