Clinical experience in airway endoscopy in children: an emphasis on the comparison between flexible and rigid endoscopy

Congenital and acquired lesions of the pediatric airway frequently pose perplexing problems in children, infants and newborns. Prompt investigation into the etiology and early intervention are essential to decrease the morbidity and to prevent some tragic events. Endoscopy grants access to the lesion sites for either diagnostic or therapeutic purposes. From April 1994 to May 1997, totally 509 endoscopic procedures, including 292 flexible and 217 rigid endoscopic procedures were performed in 296 pediatric patients at National Taiwan University Hospital. For routine diagnostic procedures, the flexible fiberscope is the instrument of choice which should include a detailed examination of entire upper airway, as farther to tracheobronchi as possible. When flexible endoscopy fails to demonstrate the exact airway lesion or certain surgical manipulation is demanded, rigid endoscopy is favored. The indications for endoscopy were: stridor, respiratory distress, follow-up endoscopy or tracheostoma evaluation, feeding difficulty, hoarseness or weak voice, and suspicious airway foreign body. Common airway problems in serial orders were: laryngomalacia, subglottic stenosis, tracheo/bronchomalacia and airway foreign body. Nearly 20% of patients in this series had multiple synchronous airway lesions. There was no major complication in our 292 flexible endoscopic procedures. Two major complications attributed to endoscopic manipulations occurred in 217 rigid endoscopic procedures.

[Relationship between thyroid echogram and thyroid function in Hashimoto's thyroiditis]

Seventeen cases of untreated Hashimoto's thyroiditis were selected from the files of the Taipei Municipal Jen-Ai Hospital during the period from Jan. 1985 to Jan. 1986. All the cases were confirmed by a physical examination, determination of thyroid antibodies and fine needle aspiration cytology. Thyroid function was also determined. According to the echogenicity of the thyroid, they were divided into 2 groups, group A (8 cases) and group B (9 cases). In group A, homogeneous hypoechogenicity of the thyroid was noted and was lower than that of the adjacent muscles. In group B, heterogeneous echogenicity of the thyroid with equal or higher echogenicity than that of the adjacent muscles was noted. Group A showed a significantly lower serum T4, T3 and a higher serum TSH in comparison with group B. Five cases in group A presented hypothyroidism clinically while only 1 in group B presented. In conclusion, in the cases of Hashimoto's thyroiditis, the homogeneous hypoechogenicity of the thyroid echogram suggested the possibility of hypothyroidism. Statistically, the sensitivity was 83.3%, specificity 72.8%, positive prediction value 62.5% and the negative prediction value was 88.9%.

Gastric xanthelasma

Gastric xanthelasmas are macroscopically well demarcated yellow or yellow-white plaques, and microscopically composed of typical foamy macrophages. Of 3870 patients who underwent upper gastrointestinal panendoscopic examinations, 30 (0.8%) were found to have gastric xanthelasma. A moderate predominance of males over females (M:F = 3.3:1) was noted. The age ranged between 21 and 69 years (mean 46.7). Frequency peaked in those from 40 to 60 years of age (53.3%). Single lesions were found in 26 patients and multiple in 4, with diameters of 1-6 mm, nearly 66.7% of which were 2-3 mm. Gastric xanthelasmas are most frequently found in the antrum (67.8%), especially along the lesser curvature. Associated chronic gastritis in the xanthelasma surrounding mucosa was found in the 30 patients and intestinal metaplasia in 4 (13.3%). The cause of gastric xanthelasma is unknown, but chronic gastritis may be the most plausible etiologic factor.