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Zakraoui M, Outman A, Kinambamba MS, Bouhrim M, Ndjib RC, Al Kamaly O, Alshawwa SZ, Seid AB, Cordier J, Ngoupayo J, Longo-Mbenza B, Gressier B, Parvez MK, Pasković I, Hamrouni L, Eto B. Ifanosine: Olea europaea L. and Hyphaene thebaica L. combination, from traditional utilization to rational formulation: Preclinical and clinical efficacy on hypertensives patients. J Ethnopharmacol 2024; 325:117834. [PMID: 38309486 DOI: 10.1016/j.jep.2024.117834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Olea europaea L. and Hyphaene thebaica L. are commonly employed by traditional healers in Africa for treating and preventing hypertension, either individually or in a polyherbal preparation (Ifanosine). AIM OF THE STUDY The primary aim was to assess the antihypertensive effects of Olea europaea L. leaves aqueous extract (OEL), Hyphaene thebaica L. mesocarp extract (HT), and the Ifanosine on isolated rat aorta rings. The secondary objective was to evaluate the clinical benefits of a new oral formulation of Ifanosine. MATERIALS AND METHODS In vitro studies using an isometric transducer examined the antihypertensive effects of HT, OEL, and Ifanosine on rat aorta. Ussing chambers technic were employed to measure mucosal to serosal fluxes and total transepithelial electrical conductance (Gt) to assess the intestinal bioavailability of HT, OEL, and Ifanosine. HPLC was utilized to determine the phytochemical composition of OEL and HT extracts. Subchronic toxicity investigations involved two groups of rats, treated with either water (control) or Ifanosine at 5 g/kg for 28 days. Clinical benefits of the new Ifanosine formulation were evaluated in an observational study with 32 hypertensive patients receiving a fixed oral dose of 3.5 mg three times a day for 30 days. RESULTS Aqueous extracts induced dose-dependent relaxation of rat aorta rings, with HT and OEL having higher IC50 values than Ifanosine (IC50 = 44.76 ± 1.35 ng/mL, 58.67 ± 1.02 ng/mL, and 29.46 ± 0.26 ng/mL, respectively). The pA2 values of OEL and HT were 1 and 0.6, respectively, while Ifanosine was 0.06. Intestinal bioavailability studies revealed better Prazosin bioavailability than plant extracts. Toxicological studies demonstrated the safety of Ifanosine, supported by histological examinations and biochemical parameters in rat blood. Biochemical analyses indicated flavonoids and phenolic acids as dominant active constituents. Clinical benefits in humans included reduced SBP, DBP, LDL-c, VLDL-c, and TAG, and increased HDL-c without overt adverse effects. CONCLUSION This study validates the traditional use of OEL and HT for hypertension and advocates for alternative and combinatorial polyphytotherapy (ACP) to enhance traditional remedies.
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Affiliation(s)
- Mariem Zakraoui
- Laboratories TBC, Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, Faculty of Phamacy, University of Lille, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France; Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia; Laboratory for the Management and development of Forest resources INRGREF, University of Carthage, Tunisia.
| | - Ahlam Outman
- Laboratories TBC, Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, Faculty of Phamacy, University of Lille, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France.
| | - Milène Simone Kinambamba
- Laboratories TBC, Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, Faculty of Phamacy, University of Lille, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France.
| | - Mohamed Bouhrim
- Laboratories TBC, Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, Faculty of Phamacy, University of Lille, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France; Laboratory of Biological Engineering, Team of Functional and Pathological Biology, Faculty of Sciences and Technology Beni Mellal, University Sultan Moulay Slimane, Beni-Mellal, 23000, Morocco.
| | - Rosette Christelle Ndjib
- Laboratories TBC, Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, Faculty of Phamacy, University of Lille, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France; Laboratory of Botany and Traditional Medicine, Institute of Medical research and Medicinal Plants Studies, B0 13033, Yaoundé, Cameroon.
| | - Omkulthom Al Kamaly
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Samar Zuhair Alshawwa
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Abakar Bechir Seid
- Direction of Pharmacopeia and Traditional Medicine, Ministry of Health and Prevention, B.P. 440, N'djamena, Chad; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Bo 1634, Yaoundé, Cameroon.
| | - Janine Cordier
- Chad-China Friendship Hospital Center, N'djamena. Chad, Chad.
| | - Joseph Ngoupayo
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Bo 1634, Yaoundé, Cameroon.
| | - Benjamin Longo-Mbenza
- Faculty of Medicine, The University of Kinshasa, Democratic Republic of Congo and LOMO University for research, LIMETE, RDC, Kinshasa, Congo.
| | - Bernard Gressier
- Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, University of Lille, Faculty of Pharmacy, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France.
| | - Mohammad Khalid Parvez
- Department of Pharmacognosy, College of Pharmacy King Saud University, Riyadh, Saudi Arabia.
| | - Igor Pasković
- Department of Agriculture and Nutrition, Institute of Agriculture and Tourism, Karla Huguesa 8, 52440, Poreč, Croatia.
| | - Lamia Hamrouni
- Laboratory for the Management and development of Forest resources INRGREF, University of Carthage, Tunisia.
| | - Bruno Eto
- Laboratories TBC, Laboratory of Pharmacology, Pharmacokinetics and Clinical Pharmacy, Faculty of Phamacy, University of Lille, 3, rue du Professeur Laguesse, B.P. 83, F-59000, Lille, France.
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Shapiro NL, Seid AB, Pransky SM, Kearns DB, Magit AE, Silva P. Adenotonsillectomy in the very young patient: cost analysis of two methods of postoperative care. Int J Pediatr Otorhinolaryngol 1999; 48:109-15. [PMID: 10375035 DOI: 10.1016/s0165-5876(99)00011-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has been the subject of many debates. Concerns for early postoperative complications such as airway obstruction, emesis, dehydration, and hemorrhage have led many physicians to consider overnight hospitalization following adenotonsillectomy in very young children. Trends in health care management have had increasing focus on cost effective means of treating patients to limit unnecessary expenditure on the part of the patient, physician, and hospital facility. The purpose of this retrospective review was to analyze two methods of early postoperative management in children less than 36 months old undergoing adenotonsillectomy at the Children's Hospital, San Diego from 1992 to 1997. Three hundred and seven cases were reviewed. Same-day discharge was compared with overnight inpatient observation based on the cost analysis of these two methods of postoperative care. Postoperative care was based on length of stay in the recovery room and as an inpatient. Expense of postoperative care was based on cost calculation for the recovery room and overnight hospitalization. Of the 307 patients, 194 went home the day of surgery and 113 were observed overnight in the hospital. Average hospital cost was higher in the outpatient group than in the inpatient group (P < 0.001). This difference reflects longer recovery room stay (350 min) in the outpatient group compared to the inpatient group (108 min) (P < 0.001). Outpatient adenotonsillectomy in the patient under 36 months may be safe; however, prolonged recovery room stays may actually make outpatient surgery less cost-effective than overnight admission. Recovery room costs are significantly higher per unit time than costs of inpatient hospitalization. Further investigation of cost-effective outpatient observation units may improve cost containment in the outpatient surgical setting.
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Affiliation(s)
- N L Shapiro
- Pediatric Otolaryngology, Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, CA 90095, USA.
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Malis DJ, Magit AE, Pransky SM, Kearns DB, Seid AB. Air in the vestibule: computed tomography scan finding in traumatic perilymph fistula. Otolaryngol Head Neck Surg 1998; 119:689-90. [PMID: 9852551 DOI: 10.1016/s0194-5998(98)70037-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- D J Malis
- Department of Pediatric Otolaryngology, Children's Hospital of San Diego, California, USA
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Abstract
There is some evidence to suggest that the incidence and complications of ACM may be increasing. However, in the current era of widespread access to health care and broad-spectrum antibiotics, an intratemporal or intracranial complication from acute otitis media may not initially be suspected. The reported case is significant in that the patient was very young, had no underlying disease or immunocompromise, and did not have a known antecedent acute otitis media. With the emergence of resistant streptococcal species and prolonged survival in immunocompromised patients, the relative incidence of complications caused by acute otitis media will probably continue to rise, making it imperative that we raise our index of suspicion for previously rare infectious complications of relatively common diseases.
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Affiliation(s)
- K K Bach
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, San Diego, CA 92134-5000, USA
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5
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Affiliation(s)
- D J Malis
- Division of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, California, USA
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Kang DR, Leong H, Foss R, Martin P, Brooker CR, Seid AB. Sutureless cartilage graft laryngotracheal reconstruction using fibrin sealant. Arch Otolaryngol Head Neck Surg 1998; 124:665-70. [PMID: 9639477 DOI: 10.1001/archotol.124.6.665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether fibrin sealant can replace suture as a means of holding a cartilage graft securely in the trachea. DESIGN Randomized blinded control study comparing the use of fibrin sealant vs sutures in laryngotracheal reconstruction in ferrets. We compared results at 7 and 30 days. SUBJECTS Forty ferrets randomized into 2 groups of 20: fibrin sealant and sutures. Within each group, half were studied at 7 days and the rest at 30 days. No ferrets were withdrawn from study because of adverse effects of the intervention. INTERVENTION A carved costal cartilage graft was placed in the anterior cricoid split incision, and was secured with either fibrin sealant or sutures. All animals were extubated after recovery from anesthesia. Specimens were examined grossly and histologically. RESULTS All animals survived until humanely killed. The pathologist, unaware of the groupings, measured lumen expansion in millimeters, cartilage graft migration, mucosal in-growth, degree of inflammation, graft integration, and graft viability. The fibrin sealant group had statistically significant (P<.05) better results in mucosal in-growth. In no categories was the suture group better than the fibrin sealant group. In comparing 7-day with 30-day results, the 30-day group had significantly better results in inflammation and graft viability. CONCLUSIONS Fibrin sealant can be used in place of sutures with improvement in mucosal growth in costal cartilage laryngotracheal reconstruction in the experimental animal model. Use of fibrin sealant (instead of sutures) may result in less surgical trauma and edema, less surgical time, and faster recovery.
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Affiliation(s)
- D R Kang
- Department of Otolaryngology, Naval Medical Center, San Diego, Calif 92134-5000, USA
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Abstract
Tonsillectomy/adenoidectomy is one of the most frequently performed operations in the United States. It is therefore likely that pediatric ENG surgeons will encounter autistic and developmentally delayed children in routine practice. Autistic children differ from normal children in that they exhibit severe deficits in language and social functioning; abnormal reaction to stimuli such as light, sound, touch, and pain; attachments to particular unusual objects and rigidly stereotyped routines. They are often mentally retarded. With the increasing importance of managed care and continuous quality improvement, knowledge of how to manage the operative course of such children is crucial for the practising surgeon. Based on research and clinical knowledge of these children, certain psychosocial and medical interventions are presented which may improve the operative course of this population. Using the parent as a consultant; decreasing separation from familiar caretakers, objects, and routines; pre-operative role-playing; tailoring anesthetic induction; and using post-operative distractors are suggested techniques.
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Affiliation(s)
- M Seid
- Center for Child Health Outcomes, Children's Hospital, San Diego, CA 92123, USA
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Abstract
Neonatal rhinitis as a distinct disease entity has not been well-studied. The recognition and treatment of this condition is important since neonates are obligate nasal breathers, and mismanagement of this entity can result in poor feeding or even death from respiratory distress. We undertook a retrospective analysis of 20 patients seen at the Children's Hospital of San Diego over the period 1990-1991. Eighteen patients developed neonatal rhinitis in the months of August to January and only two between February and July. Clinical presentation and an effective management algorithm are discussed. Early recognition on the basis of clinical features followed by a two-step therapeutic trial consisting of conservative therapy and corticosteroid drops are advocated. Based on the above findings we have defined neonatal rhinitis as mucoid rhinorrhea with nasal mucosal edema in the afebrile newborn that results in stertor, poor feeding and respiratory distress which responds promptly to decadron 0.1% drops within a week. We recommend reserving diagnostic procedures for complicated cases that do not respond to the proposed regimen.
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Affiliation(s)
- C O Nathan
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Medical Center, Shreveport 71130, USA
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9
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Abstract
In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheostomy was necessary in 13 children. Bi-level positive airway pressure (BiPAP) was used successfully in 2 children and tracheotomy was avoided. Treatment still needs to be better defined.
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Affiliation(s)
- P Froehlich
- Département d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital E. Herriot, Lyon, France
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Abstract
The standards of treatment of subglottic hemangiomas are steroids and laser vaporization. If these methods do not provide a sufficient airway, a tracheotomy may be required. Analysis of the data available in the literature shows that there is a place for other therapeutic solutions. Open surgical excision could be one of them but is controversial. So far, it represented a 'last' resort procedure before tracheotomy. Our approach to open surgical excision is different. A prospective decision is taken in the initial therapeutic approach. Infants are considered candidates for excision in cases of large hemangiomas that extend beyond the limits of laser. Laser is, then, avoided in order not to damage the overlying mucosa. Interferon is not utilized because a rapid effect is not expected on the respiratory distress. Open surgical excision without tracheotomy is performed. A cricoid enlargement is associated at the end of the procedure. Risk for post-operative subglottic stenosis is limited. When conceived this way, open surgical excision seems effective to manage large life-threatening hemangiomas.
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Affiliation(s)
- P Froehlich
- Départment d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital E. Herriot, Lyon, France
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Abstract
Nager acrofacial dysostosis, first described by Nager and deReynier in 1948, is a rare syndrome characterized by mandibulofacial dysostosis with associated radial defects. The facial features include downward slanting palpebral fissures, absent eyelashes in the medial third of the lower lids, mandibular and malar hypoplasia, dysplastic ears with conductive deafness, and variable degrees of palatal clefting. Upper limb malformation is a constant feature of Nager syndrome and ranges from thumb hypoplasia to absence of the radial ray. The maxillo-mandibular hypoplasia and associated retroplaced tongue set the stage for early and significant upper airway obstruction. The craniofacial anomalies and associated trismus make emergent airway intubation challenging. We present a case of Nager syndrome with life threatening airway obstruction unresponsive to conservative management. This case and a review of the literature emphasize the importance of early tracheotomy for these patients.
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Affiliation(s)
- R A Friedman
- Department of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, California 92123, USA
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12
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Abstract
A destructive granulomatous lesion of the temporal bone caused by Coccidioides immitis disseminated from a pulmonary lesion was found in a 4-year-old immunocompetent child. To our knowledge, it is the first case of coccidioidomycosis of the temporal bone reported in the world literature. The child presented with pain in her right ear and a 6-month history of intermittent fever, which partially responded to multiple courses of antibiotics. A tender erythematous postauricular swelling consistent with a subperiosteal abscess subsequently developed over 1 month. A mastoidectomy showed granulation tissue with pockets of purulence, and histologic evaluation of the specimen revealed spherules of C immitis, later verified by culture. The patient responded to intravenous amphotericin B therapy, without evidence of disease recurrence. Coccidioides immitis is endemic in regions of the Southwestern United States, with extremely infectious characteristics and relative resistance to medical therapy. Coccidioidomycosis should be considered in the differential diagnosis of a granulomatous lesion of the temporal bone.
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Affiliation(s)
- W S Low
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, School of Medicine, USA
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13
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Abstract
Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high mortality rate. The principles of one-stage laryngotracheoplasty have been adapted to the surgical management of CTS. Three children underwent a one-stage anterior tracheoplasty with costal cartilage grafting and without cardiopulmonary bypass. Extubation was performed within 13 days. One child developed granulation tissue one month postoperatively, and this was removed endoscopically. The three children were free of respiratory obstruction signs during follow-up ranging from 8 months to 3 years. Postoperative endoscopies have shown growth of the grafted trachea.
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Affiliation(s)
- P Froehlich
- Departement d'ORL, Hôpital E. Herriot, Lyon, France
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14
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Abstract
Subglottic hemangioma is an unusual entity which may involute spontaneously without aggressive surgical intervention; although tracheotomy is sometimes necessary. The actual time course for involution is not clear by reviewing the literature [1,14]. Numerous treatment modalities are described for the treatment of this condition, including tracheotomy, CO2 laser ablation and intralesional steroid injection with or without endotracheal intubation. Surgical resection of subglottic hemangioma is an option which is described in the literature and may be utilized in certain selected cases. We present seven cases of subglottic hemangioma treated at three institutions which were resected via a crico-tracheotomy approach. Postoperative follow-up for these patients range from 6 months to 4.5 years. Although conservative measures are still advocated as the treatment of choice for subglottic hemangioma, open surgical resection may be indicated in selected cases resulting in a satisfactory outcome.
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Affiliation(s)
- B J Wiatrak
- Children's Hospital of Alabama, Birmingham, USA
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Froehlich P, Seid AB, Kearns DB, Pransky SM, Morgon A. Use of costal cartilage graft as external stent for repair of major suprastomal collapse complicating pediatric tracheotomy. Laryngoscope 1995; 105:774-5. [PMID: 7603286 DOI: 10.1288/00005537-199507000-00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P Froehlich
- Département d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôptial E. Herriot, Lyon France
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Abstract
Among controversies in pediatric otorhinolaryngology, the role of gastroesophageal reflux (GER) in inflammatory disorders of the upper airway remains of major concern. A laryngeal involvement by GER was demonstrated in adults and a correlation with GER has been found in pediatric populations with recurrent croup. However, although considered statistically significant, these results concern a few patients only and are inconclusive for a causal relationship. In addition, pH monitoring, often considered as the gold standard for the diagnosis of GER disease, has failed in giving normal values in ENT disorders. Eventually, upper pharyngeal and nasal involvements by GER and GER-related otitis media or otalgia have been suggested by some authors. In the 6th International Congress on Pediatric Otolaryngology, the Symposium on GER was designed to help physicians in improving their knowledge of the data from the literature and their understanding of the involved mechanisms. Bearing in mind the potential severity of GER disease, the audience also heard and debated the most up-to-date methods of assessing GER and treating it in patients with possibly related otorhinolaryngological symptoms. Here is the summary of this symposium.
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Affiliation(s)
- P Contencin
- ORL, Hôpital Saint-Vincent-de-Paul, Paris, France
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17
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Abstract
Neonatal otitis media may be an isolated infection or part of a more complex sepsis syndrome. Because early studies suggested that the microbiologic characteristics of neonatal otitis media included a high risk of gram-negative coliforms and Staphylococcus aureus, tympanocentesis was recommended routinely. Subsequent studies have supported empiric medical therapy in selected patients, reserving tympanocentesis for patients in whom medical treatment fails. Because of these conflicting recommendations, records from 37 neonates with otitis media who underwent tympanocentesis from 1986 through 1991 were studied retrospectively. Cultures in one outpatient (11%) and four inpatients (13%) yielded Escherichia coli, all of which were sensitive to amoxicillin. No cultures of S aureus were identified. Sterile cultures and pneumococcus isolates were found most frequently. No septic or intracranial complications were noted. All patients were discharged on regimens of routine antibiotics for otitis media.
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Affiliation(s)
- D M Burton
- Otolaryngology Department, Children's Hospital and Health Center, San Diego, Calif
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19
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Abstract
Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of "silent" GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.
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Affiliation(s)
- D M Burton
- Department of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, California
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20
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Abstract
Congenital rests of gastric epithelium have been reported in a variety of head and neck locations. Presenting symptoms of these lesions range from an asymptomatic cyst to one which is compromising the airway. The true diagnosis is rarely suspected prior to excision. A case of a gastric choristoma of the tongue is presented which was noted at birth as an intermittently bleeding ulcer. Complete excision of the mass was difficult to ascertain due to poor delineation of the tumor margins from the tongue musculature. A postoperative technetium-99m pertechnetate scan failed to demonstrate residual gastric mucosa. Conservative management resulted in only transient healing of the ulcer. Repeat excision demonstrated abundant residual gastric mucosa. Technetium-99m pertechnetate scanning may not be a reliable indicator of ectopic gastric mucosa in the head and neck region.
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Affiliation(s)
- D M Burton
- Children's Hospital and Health Center, San Diego, CA
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21
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Abstract
The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.
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Affiliation(s)
- D M Burton
- Children's Hospital and Health Center, San Diego, CA
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22
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Abstract
Based on this patient's history and the imaging studies, all the consultants agree that they are dealing with a juvenile nasopharyngeal angiofibroma. They agree that a biopsy is not necessary. However, angiography would be obtained by 2 physicians (Drs. Seid and Weber). When treating an extensive JNA, the consultants differ in their approaches. One favors a lateral infratemporal fossa approach (Dr. Gantz), but the others favor a combined approach (Drs. Seid and Weber). In this particular case, 2 experts favor resection (Drs. Gantz and Weber), but one would irradiate (Dr. Seid). There is also disagreement regarding the severity of morbidity. Minor problems include conductive hearing loss, paresis of the third division of the fifth cranial nerve (Dr. Gantz), and a transient facial nerve paralysis (Dr. Weber). They are more concerned about the long-range problems from skull-base radiotherapy including brain-stem compromise, pituitary dysfunction, and radiation-induced malignancies. No one suggests chemotherapy or multimodal therapy. Regarding the natural history of JNA, the views range from no spontaneous regression (Dr. Gantz), gradual involution over time (Dr. Seid), or an indolent nature that requires tapering the treatment to the benign nature of the process (Dr. Weber).
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Affiliation(s)
- B Gantz
- Department of Otolaryngology--Head and Neck, University of Iowa, Iowa City
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Seid AB, Godin MS, Pransky SM, Kearns DB, Peterson BM. The prognostic value of endotracheal tube-air leak following tracheal surgery in children. Arch Otolaryngol Head Neck Surg 1991; 117:880-2. [PMID: 1892619 DOI: 10.1001/archotol.1991.01870200074011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In an effort to determine if the endotracheal tube-leak pressure has prognostic value in relation to a successful outcome after one-stage laryngotracheal reconstruction or cricoid split surgery, a retrospective analysis was performed on 17 children who had undergone such surgery. The daily leak pressures, length of intubation, and ultimate outcome of attempts at extubation were noted. One hundred percent of patients with a leak pressure of less than 20 cm H2O on the day before extubation were successfully extubated. In contrast, the failure rate was 100% in children extubated with a leak of greater than 30 mm H2O. The difference between these two groups was statistically significant (chi 2, 13.03). Sixty percent of patients with leak pressures in the range of 21 to 30 cm H2O were successfully extubated. The endotracheal tube-leak pressure is a parameter that has prognostic value, and should be considered in determining when to extubate children who have undergone tracheal reconstructive surgery.
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Affiliation(s)
- A B Seid
- Department of Otolaryngology, Children's Hospital and Health Center, San Diego, Calif
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Pransky SM, Feldman JI, Kearns DB, Seid AB, Billman GF. Actinomycosis in obstructive tonsillar hypertrophy and recurrent tonsillitis. Arch Otolaryngol Head Neck Surg 1991; 117:883-5. [PMID: 1892620 DOI: 10.1001/archotol.1991.01870200077012] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A quantitative analysis of adenoid and tonsillar specimens from 460 patients was performed. The patients underwent tonsillectomy or adenotonsillectomy for either recurrent tonsillitis or obstructive tonsillar hypertrophy. Histologic preparations revealed Actinomycetes as statistically more prevalent in the obstructive population. The presence of Actinomycetes in the adenotonsillar core of this diagnostic group may indicate an etiologic role for this organism in tonsillar and adenoidal hypertrophy.
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Affiliation(s)
- S M Pransky
- Department of Otolaryngology, Children's Hospital and Health Center, San Diego, Calif
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25
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Abstract
The management of subglottic hemangioma in infants remains controversial. We report two patients in whom an open surgical approach was utilized to completely excise the subglottic hemangioma. Both children have been successfully extubated and have remained symptom-free since that time.
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Affiliation(s)
- A B Seid
- Department of Pediatric Otolaryngology, Children's Hospital and Health Center, San Diego, CA
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26
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Braganza RA, Kearns DB, Burton DM, Seid AB, Pransky SM. Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants. Cleft Palate Craniofac J 1991; 28:305-7. [PMID: 1911820 DOI: 10.1597/1545-1569(1991)028<0325:uotbii>2.3.co;2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Four case reports of infants with cleft palate and intractable otorrhea following the placement of pressure equalization tubes are presented. In one patient, liquids taken orally were noted to reflux through her ears. Otorrhea was refractory to medical management in all cases and was controlled only after closure of the soft palate. Persistent otorrhea may be an indication for early closure of the soft palate in these infants.
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Affiliation(s)
- R A Braganza
- Division of Head and Neck Surgery, University of California, San Diego
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27
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Abstract
This article documents the evolution of our approach to the repair of subglottic stenosis in infants. With increasing experience in the management of subglottic stenosis using the anterior cricoid split procedure, we extended our procedure to include older children. This then led to the use of the one-stage procedure for repair of severe and mature subglottic stenosis. We present the results of surgical repair in 13 patients. Extubation was accomplished in 12 of 13 patients using one-stage laryngotracheoplasty.
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Affiliation(s)
- A B Seid
- Department of Otolaryngology, Children's Hospital and Health Center, San Diego, Calif
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28
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Kearns DB, Pransky SM, Seid AB. Current concepts in pediatric adenotonsillar disease. Ear Nose Throat J 1991; 70:15-9. [PMID: 2065614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
More objective thinking regarding the indications for adenotonsillar surgery has gained new respect for these operations. Better understanding of the implications of adenoid disease in chronic otitis and sinusitis, along with appreciation of obstructive airway problems secondary to adenotonsillar hypertrophy, has changed the scope of the operation. Research is ongoing to determine the etiology of chronic antigenic stimulation as a cause for hypertrophy of these organs.
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Affiliation(s)
- D B Kearns
- Pediatric Otolaryngology Associates, San Diego, California 92103
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29
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Abstract
Robin Sequence is a well-described disorder with a reported incidence of 1 in 2000 births. It is characterized by glossoptosis and micrognathia often associated with a cleft palate. Respiratory obstruction at the level of the tongue occurs in many affected children. Prior to routine intensive care unit management, it was the primary factor in the mortality reported in patients with moderately severe to severe deformity. Treatment of this obstruction is controversial and may include a long stay in an intensive care setting. We report two cases that demonstrate properly placed and constructed nasopharyngeal tubes allow a non-surgical treatment with early discharge of the patient and without the risks and morbidity of surgery or the complications of tracheostomy.
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Affiliation(s)
- T S Olson
- Department of Otolaryngology, Children's Hospital, San Diego, CA
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30
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Abstract
Nontuberculous mycobacteria (NTM) are an important cause of cervicofacial lymphadenitis in children. A dramatic increase has been seen in confirmed cases of NTM lymphadenitis in San Diego in the past few years. This report encompasses a span of 2 years 9 months, during which 22 children had confirmed NTM infection and another 14 had necrotizing granulomatous lymphadenitis in whom the specific diagnosis of NTM could not be made. This apparent increase in the prevalence of NTM as compared to previous reports in the literature suggests a possible endemic risk for NTM in the San Diego area. These cases are reviewed and our diagnostic and surgical approach to possible NTM infection is described. We also discuss possible explanations for the increasing occurrence of NTM in the San Diego area.
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Affiliation(s)
- S M Pransky
- Department of Otolaryngology, Children's Hospital, San Diego, CA
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31
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Abstract
The complete surgical extirpation of branchial cleft abnormalities is essential in avoiding recurrent disease. The most technically difficult maneuver is often the localization and excision of associated sinus tracts and fistulae. The authors communicate a simple yet effective technique for dealing with this difficulty utilizing the Fogarty embolectomy catheter.
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Affiliation(s)
- J I Feldman
- Department of Surgery, University of California San Diego 92103
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32
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Abstract
Juvenile nasopharyngeal angiofibromas (JNA) by definition originate in the nasopharynx. Vascular tumors arising in the nasal cavity can easily be mistaken for JNA, when the correct diagnosis is hemangioma or angiofibromatous polyp. We present a case that illustrates this problem, an 11-year-old boy with a unilateral anterior nasal cavity mass associated with recurrent epistaxis. At surgery, the mass was found to arise from the anterior nasal septum and was removed easily with minimal bleeding. The initial pathologic interpretation was JNA. After extensive review of the specimen, however, the diagnosis of hemangioma was made. Similar tumors have been reported as being JNA that have been simple to remove with minimal blood loss. JNA is associated with more severe blood loss, is more difficult to expose surgically and has a higher risk of recurrence than other nasal tumors. Therefore, JNA needs to be distinguished from anterior nasal cavity masses.
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Affiliation(s)
- J W Ochi
- Children's Hospital and Health Center, San Diego, CA
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33
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Abstract
Obstructive sleep apnea is the underlying cause of a variety of pediatric maladies, including pulmonary hypertension and failure to thrive. In children, unlike adults, obstruction secondary to lymphoid hyperplasia is often encountered; adenotonsillectomy restores airway patency. Patients who fail this procedure, such as children with cerebral palsy and associated muscular hypotonia, may face tracheotomies. We report on 10 pediatric patients with severe mental insufficiency and obstructive sleep apnea in whom palatal hypotonicity and lack of adenotonsillar hypertrophy was identified. Uvulopalatopharyngoplasty was performed in conjunction with adenotonsillectomy to enlarge the diameter of the nasopharyngeal inlet with successful resolution of the obstructive symptoms in eight patients. The remaining two children required more surgery. This procedure is presented as a possible alternative to tracheotomy in selected patients.
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Affiliation(s)
- A B Seid
- Pediatric Otolaryngology Associates, Naval Hospital San Diego, Calif
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34
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Abstract
Pelizaeus-Merzbacher disease is a condition of central nervous system dysmyelination. We describe a familial series in which both otologic and laryngologic abnormalities were present. The diagnosis of this invariably fatal disorder can be made on a clinical and/or pathologic basis. As the otolaryngologic manifestations are often the first to appear, the consulting head and neck surgeon may be essential in the initial diagnosis of this hereditary disease.
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Affiliation(s)
- J I Feldman
- Department of Surgery, University of California, San Diego
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35
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Affiliation(s)
- A B Seid
- Pediatric Otolaryngology Associates, San Diego, CA 92103
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36
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Abstract
The fourth branchial pouch sinus is a congenital anomaly which most frequently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is more common than has previously been suspected. It has been found on the left side in 93% of the 28 cases reported in the English literature. Barium swallow during periods of quiescence and nasopharyngoscopy have frequently been successful in identifying the presence of these embryological remnants. Definitive therapy consists of total excision of the sinus tract, which can be facilitated by direct endoscopic placement of a Fogarty catheter into the sinus lumen before surgical exploration. The embryological basis for the occurrence of these sinuses is discussed.
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Affiliation(s)
- M S Godin
- Department of Pediatric Otolaryngology--Head and Neck Surgery, Children's Hospital and Health Center, San Diego, Calif
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37
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Affiliation(s)
- D B Kearns
- Department of Otolaryngology, Children's Hospital and Health Center, San Diego, CA
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38
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Abstract
Actinomycosis is an uncommon infection of the middle ear. Only 21 cases of actinomycosis of the middle ear have been reported in the English literature prior to this paper. The offending organism is Actinomyces israelii, which is an anaerobic, filamentous organism that is difficult to grow in culture. The infection is chronic and is seldom diagnosed prior to tympanomastoidectomy. The identification of small, yellow, glue-like masses, which are called sulfur granules, is often the key to making the diagnosis of actinomycosis of the middle ear. Following tympanomastoidectomy, penicillin is given orally for 3-6 months.
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Affiliation(s)
- T S Olson
- Children's Hospital and Health Center, San Diego, CA
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39
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Abstract
The cricoid split operation is a well established treatment for subglottic stenosis; the success rate for this procedure is approximately 77%. The management of patients who fail this operation has traditionally involved tracheostomy followed by delayed laryngotracheoplasty. We have treated 22 patients using the cricoid split--6 required subsequent tracheostomy. Two-thirds of the patients with a tracheostomy have been unable to be decannulated, even after laryngotracheoplasty. In contrast, 3 patients had repeat cricoid split operations instead of tracheostomy. All 3 of these children have had no further problems with their airway. The authors propose that in patients who fail the cricoid split operation one consider repeating the procedure instead of performing a tracheostomy.
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Affiliation(s)
- J W Ochi
- Children's Hospital and Health Center, San Diego, CA
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40
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Abstract
Laryngomalacia is an entity of ill-defined etiology. The clinical situation is one of inspiratory stridor present at birth, or within the newborn period. The stridor may increase in severity for the first several months of life and thereafter spontaneously begins to resolve. In the majority of cases the condition resolves spontaneously by approximately two years of age. This report will present the surgical management of severe laryngomalacia in infants using the carbon dioxide laser to surgically divide the aryepiglottic fold with resolution of the laryngomalacia.
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41
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Abstract
Severe acquired subglottic stenosis occurs most commonly in infants and children who require long-term ventilatory support with indwelling endotracheal tubes for underlying respiratory disease. A variety of operative and endoscopic procedures have been advocated for this problem including endoscopic fulguration, cryotherapy, direct incision or excision, and several types of extensive direct laryngotracheoplasties. The failure rate with these procedures is high. We have treated 22 patients including 12 neonates and 10 older children with acquired airway injury and obstruction with a simple cricoid split. In 15 patients the airway obstruction was completely relieved and these youngsters were extubated without difficulty. An additional 3 patients failed initial extubation which was subsequently successful, however, after repeat intubation for a short period of time. Endoscopic follow-up shows complete healing of the incised area. In 2 neonates the procedure was unsuccessful, and tracheotomy was needed. One of these had additional severe airway injury in the distal tracheobronchial tree secondary to selective bronchial intubation in the newborn period. Two older children also required tracheotomy because of severe airway scarring unrelieved by this procedure. The cricoid split is a simple and successful way of dealing with subglottic stenosis, especially in the newborn premature infant. A significant advantage is that it disturbs the anatomy very little, allowing for more extensive laryngotracheoplasty in the future should it fail.
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42
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Frankel LR, Anas NG, Perkin RM, Seid AB, Peterson B, Park SM. Use of the anterior cricoid split operation in infants with acquired subglottic stenosis. Crit Care Med 1984; 12:395-8. [PMID: 6705550 DOI: 10.1097/00003246-198404000-00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspiration of meconium and the other intubation for obstructive apnea. All had been extubated successfully in less than 2 wk and were discharged home with no signs of subglottic stenosis. These infants were referred at 2 to 13 months of age for evaluation of upper airway obstruction. By bronchoscopy, we confirmed severe subglottic stenosis in each of the infants. The anterior cricoid split procedure requires a single midline vertical incision through the anterior cartilaginous ring of the cricoid cartilage and the upper 2 tracheal rings. Our postoperative management included 7 to 10 days of endotracheal intubation, mechanical ventilation, neuromuscular blockade, sedation, and total parenteral nutrition. All were extubated at the end of this period without evidence of stridor or obstructive apnea. One patient developed a subglottic granuloma at the level of the cricoid cartilage 4 months after the operation; this was successfully excised with the carbon dioxide laser. The other 9 patients remain asymptomatic 1 month to 1 yr after the surgical repair.
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43
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44
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Abstract
The combined craniofacial resection is a well-established method of managing invasive primary malignant nasoethmoidal disease in adults, and serves as an excellent surgical technique for the en bloc eradication of these lesions [6]. The nasoethmoid region is a relatively uncommon site for the development of primary carcinoma. Less than 3% of cancers involving the adult upper aerodigestive system arise in this area [11,13]. Because similar lesions occur in the pediatric population even less frequently, there has been little opportunity to gain the knowledge necessary to develop a standardized treatment of this disease in children. We report the use of a combined therapeutic regimen consisting of cobalt-60 radiotherapy, surgery and chemotherapy, to manage a primary malignant undifferentiated carcinoma of the ethmoid complex in an adolescent. Since the initiation of treatment at the Cincinnati Children's Hospital, the child has remained free of tumor for 24 months. The techniques of craniofacial resection for the removal of certain tumors in the nasoethmoid complex of adults may be easily adapted for use in the pediatric population, and should be included in the surgical armamentarium of the otolaryngologist providing this type of health care for children.
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45
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Abstract
A case of lipoblastic liposarcoma of the neck is presented. The case is that of a 5-year-old female who underwent a modified neck dissection with a good result. A review of the literature reveals that this is an extremely rare tumor of the neck. It is usually found in the lower extremities, predominantly in adult males. Surgery is the treatment of choice. Lipoblastic liposarcoma is an extremely rare tumor when it occurs in the pediatric neck. Hudson and Saunders in their studies have shown that only 3 patients with this tumor have been reported since 1944. When a 5-year-old female presented with this primary neck mass, questions of diagnosis and treatment were raised. The following case report and discussion will demonstrate the diagnostic methods as well as the course of therapy followed in this type of lesion.
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46
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Abstract
At Groote Schuur Hospital, Cape Town, over a 5-year period (1974 to 1978) 15 patients with squamous cell carcinoma of the larynx or hypopharynx have had planned 2,000 Rad Telecobalt therapy followed by supraglottic horizontal laryngectomy. Five patients following surgery had a further 3,600--4,000 Rad Telecobalt therapy. The peri-operative complications, in addition to those of whole organ resection, included debilitating laryngeal incompetence in three patients, two of whom underwent total laryngectomy. All 15 patients have remained free of recurrent disease for 2 years and 10 have been free for 3 or more years. One patient died 4 years after surgery from a primary bronchial carcinoma.
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47
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Cotton RT, Richardson MA, Seid AB. Panel discussion: the management of advanced laryngotracheal stenosis. Management of combined advanced glottic and subglottic stenosis in infancy and childhood. Laryngoscope 1981; 91:221-5. [PMID: 7464384 DOI: 10.1288/00005537-198102000-00008] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Severe glottic and subglottic stenosis in infants and children is a formidable disease for a child and a difficult reconstructive problem for the surgeon. Twelve consecutive patients are described in this series, 7 of whom had complete airway obstruction; 9 patients have been extubated with satisfactory voices. Long-term follow-up indicates no cases of decreased development of the larynx.
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48
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Cotton RT, Seid AB. Management of the extubation problem in the premature child. Anterior cricoid split as an alternative to tracheotomy. Ann Otol Rhinol Laryngol 1980; 89:508-11. [PMID: 7458136 DOI: 10.1177/000348948008900604] [Citation(s) in RCA: 152] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Long-term endotracheal intubation is a widely established means of giving ventilatory support in the newborn period. Though such long-term intubation is well tolerated by the premature infant, laryngeal complications do occur and extubation may be impossible even though the initial disease process for which the intubation was performed has resolved. In such a situation, careful endoscopic evaluation of the upper respiratory tract is advocated to identify the site of the problem. If subglottic edema or mucosal ulceration in the subglottic area is the site of the damage and if, during endoscopic evaluation immediately following removal of the endotracheal tube, the subglottic area starts to narrow because of edema formation or edema fluid filling up compressed granulation tissue, then a split of the cricoid in the midline anteriorly, leaving the endotracheal tube in as a stent, appears to be a preferable alternative to performing a tracheotomy. Of 12 consecutive patients, 9 have been successfully extubated.
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49
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Lesinski SG, Fox JM, Seid AB, Bratcher GO, Cotton R. Does the Silastic Eustachian Tube prosthesis improve eustachian tube function? Laryngoscope 1980; 90:1413-28. [PMID: 7190631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This clinical study attempts to evaluate the effectiveness of Eustachian tube function in 30 ears, 11-29 months after insertion of the Silastic Eustachian tube prosthesis (SETP). Indications for the SETP were limited to persistent Eustachian tube dysfunction. Preoperatively, 13 patients had intact tympanic membranes with persistent serous otitis media. Seventeen patients underwent tympanoplasty and demonstrated persistent serous otitis media in the opposite ear. Postoperatively, aeration of the middle ear was evaluated by tympanometry, microscopic examination, and myringostomy. Microphotographs demonstrate the state of the middle ear. Histology of the middle ear mucosa was obtained in a few cases. Ninety-six percent of the ears with an SETP demonstrated confirmed persistent Eustachinan tube dysfunction beginning an average of six months after insertion. Complications were common.
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50
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Abstract
Two children, one with an internal laryngocele and the other with a lateral saccular cyst are described. The anatomy, classification, and history of these unusual lesions are described. The diagnosis and management are discussed. An external approach is suggested for the more persistent cases.
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