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Pazinatto DB, Maunsell R, Avelino MAG, Lubianca Neto JF, Schweiger C, Caldas JPDS, Brandão MB, Souza PPD, Peixoto FADO, Ricachinevsky CP, Silveira RC, Andreolio C, Miura CS, Volpe DDSJ, Ferri WAG, Gavazzoni FB, João PRD, Possas SA, Chone CT. Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion. Braz J Otorhinolaryngol 2024; 90:101401. [PMID: 38428330 PMCID: PMC10912835 DOI: 10.1016/j.bjorl.2024.101401] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/26/2023] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. METHODS A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. RESULTS Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. CONCLUSIONS Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.
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Affiliation(s)
| | - Rebecca Maunsell
- Universidade Estadual de Campinas (UNICAMP), Hospital de Clínicas, Campinas, SP, Brazil
| | | | | | | | | | | | | | | | | | - Rita C Silveira
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Hospital de Clínicas, Campinas, SP, Brazil
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Dos Santos MO, Manica D, Cauduro Marostica PJ, Kuhl LP, Collares MV, Schweiger C. Mid-term effect of mandibular distraction osteogenesis on clinical and polysomnography findings of patients with Robin sequence. J Craniomaxillofac Surg 2024; 52:55-58. [PMID: 37884434 DOI: 10.1016/j.jcms.2023.08.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 10/28/2023] Open
Abstract
The study aimed to evaluate the mid-term effect of MDO in children with Robin sequence (RS). In this case series, 13 patients with RS who underwent MDO were followed up for more than 5 years. Data were collected using clinical history and physical examination. Polysomnography was performed and endoscopic evaluations of the airway was performed if patients still presented obstructive signs of upper airways and/or dysphagia. The patients' clinical signs improved in the mid-term after versus before MDO (inspiratory noise, 92,3% vs 30,8%; apnea, 84,6% vs 7,7%; cyanosis, 76,9% vs 0%; desaturations, 69,2% vs 0%; and suprasternal/intercostal retractions, 61,5% vs 0%; p < 0.05). Statistically significant improvement was noted in the following polysomnographic parameters evaluated in the pre and postoperative mid-term: apnea-hypopnea index, total sleep time and desaturation index (p < 0.05). Within the limitations of the study it seems that MDO is an effective surgical option for children with RS, not only in the short term as previously demonstrated, but also in the mid-term.
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Affiliation(s)
- Marcele Oliveira Dos Santos
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otorhinolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Pediatric Pulmonology Unit, HCPA, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - Leonardo Palma Kuhl
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil
| | | | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otorhinolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
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de Castro SF, Kuhl LP, Kunde L, Manica D, Procianoy RS, Marostica PJC, Schweiger C. Endoscopic evaluation of neonates with signs of upper airway obstruction in the neonatal unit of a tertiary hospital. J Perinatol 2023; 43:1481-1485. [PMID: 37816803 DOI: 10.1038/s41372-023-01772-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION The aim of the study is to evaluate major causes of upper airway obstruction in newborns receiving healthcare at our institution, their method of endoscopic assessment and the rate of complications related to these procedures. MATERIALS AND METHODS This is a case series study of patients from institutional neonatal intensive care unit (NICU) presenting signs of ventilatory dysfunction for whom an endoscopic airway assessment was warranted. Information of interest was collected from medical records according to a Clinical and Endoscopic Assessment Protocol created for the study. The protocol included clinical manifestations needing ENT evaluation, clinical signs of ventilatory dysfunction, comorbidities (pulmonary, cardiac, neurological, and gastrointestinal), examination method (airway endoscopy under general anesthesia or awake), exam complications, and final diagnosis. RESULTS One hundred sixty-nine newborn patients who underwent airway endoscopy (awake bedside flexible fiberoptic laryngoscopy (FFL) or direct laryngoscopy and bronchoscopy (DLB) in the surgical ward) were included. Thirty-nine patients (23.07%) underwent bedside FFL. For the remaining 130 who underwent DLB under general anesthesia, the median procedure time was 30 min (20-44). Only 9 (5.32%) patients presented complications: desaturation (4), laryngospasm without desaturation with spontaneous resolution (2), apnea with resolution after stimulation (1), seizures (1), nasal bleeding (1). The most frequent diagnoses found were glossoptosis, posterior laryngeal edema, and laryngomalacia. CONCLUSION This retrospective case series describes the prevalence of different pathologies that cause upper airway obstruction in neonates. Airway endoscopy seems an effective and safe diagnostic tool in neonatal airway obstruction. Glossoptosis was the most prevalent cause of obstruction in our center.
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Affiliation(s)
- Samantha Fernandez de Castro
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Leonardo Palma Kuhl
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Luciana Kunde
- Medical School, Universidade Luterana do Brasil (ULBRA), Canoas, Brazil
| | - Denise Manica
- Otolaryngology/Head and Neck Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Renato Soibelmann Procianoy
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Neonatology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Otolaryngology/Head and Neck Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Gasparin M, Barth FL, Pauletti LF, Simon MISDS, da Nóbrega Figueiredo RI, Schweiger C, Levy DS, Marostica PJC. Therapeutic Management with Airway Clearance in Children with Robin Sequence and Association with Swallowing Outcomes: A Systematic Review and Meta-analysis. Dysphagia 2023; 38:1267-1276. [PMID: 36763186 DOI: 10.1007/s00455-023-10561-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Dysphagia in Robin Sequence can be present in varying degrees, requiring multidisciplinary management and specific swallowing assessment by a specialist. Most studies published to date have evaluated only respiratory outcomes, and the available evidence on the improvement of swallowing is questionable. To conduct a systematic review and meta-analysis of studies evaluating swallowing in children with Robin Sequence before and after airway clearance procedures. The research question was developed based on the PICO strategy. The literature search was performed in electronic databases and gray literature. Studies were selected by 3 independent reviewers. The risk of bias and level of evidence of the studies were assessed. A proportion meta-analysis was performed to calculate the prevalence of dysphagia after airway clearance procedures. The search identified 4938 studies, 5 of which were included. All studies had limitations in terms of design and sample size. The prevalence of dysphagia after airway clearance was obtained by analyzing treatment subgroups: mandibular distraction osteogenesis, mandibular distraction osteogenesis + tracheostomy tube, and nasopharyngeal tube. Clinical and/or instrumental assessment was assessed by a swallowing specialist. The meta-analysis was precluded by the limitations of the studies, especially regarding sample size, which affected the accuracy of the findings. Dysphagia remained unresolved in 55% of children (95% CI 1-99%). The methodological quality of the studies indicated a high risk of bias and very low level of evidence. It was not possible to confirm that airway clearance techniques used in Robin Sequence improve dysphagia.
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Affiliation(s)
- Marisa Gasparin
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
| | - Fabiola Luciane Barth
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
| | - Luciane Ferreira Pauletti
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
| | - Miriam Izabel Souza Dos Santos Simon
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
| | | | - Cláudia Schweiger
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Department of Otolaryngology, Pediatric Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Av. Protásio Alves, 211, Porto Alegre, RS, 90035-903, Brazil
| | - Deborah Salle Levy
- School of Speech-Language Pathology and Audiology, UFRGS, Rua Ramiro Barcelos 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Paulo José Cauduro Marostica
- Graduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Department of Pediatrics, Pediatric Pulmonology Unit, HCPA, Rua Ramiro Barcelos, 2350, Av. Protásio Alves, 211, Porto Alegre, RS, 90035-903, Brazil
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Vasconcellos Severo G, Schweiger C, Manica D, Marostica PJC. Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:71-76. [PMID: 35915024 DOI: 10.1016/j.anorl.2022.07.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 11/03/2022]
Abstract
AIMS To verify the prevalence of Potentially pathogenic bacteria (PPB) and their antimicrobial resistance profile in tracheal aspirates of children with tracheostomy and compare it to clinical data. METHODS A cross-sectional study was conducted in patients aged 0-18 years who all underwent tracheostomy cannula change (TCC) performed by the Otolaryngology Unit at Hospital de Clínicas de Porto Alegre, Brazil, between October, 2017 and December, 2018. Patients were submitted, at the time of TCC, to a tracheal aspirate through the tracheostomy and secretion was sent to microbiological analysis and antimicrobial susceptibility testing. Clinical data were evaluated through available patients' electronic medical records. RESULTS Forty-four patients had their tracheostomy aspirate cultured and all but one presented PPB growth (97.7%). Median age was 3 years-old. Pseudomonas aeruginosa was the most prevalent bacteria (56.9%) and it was resistant to gentamycin, amikacin and cefepime in 36%, 28% and 12% of the culture tests, respectively. P. aeruginosa resistance to gentamycin and to cefepime suggested an association with the number of antibiotic classes used in the 12 months before enrollment (both p=0.04) and with 2 or more hospital admissions in the same period (p=0.03 and p=0.02, respectively). Staphylococcus aureus was isolated in 9.1% and there was no MRSA. CONCLUSION It was found a 97.7% prevalence of PPB in the cultured aspirates; the most prevalent bacterium was P. aeruginosa and there was no MRSA identification. Data suggest an association between P. aeruginosa antimicrobial resistance with previous use of antibiotic therapy.
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Affiliation(s)
- G Vasconcellos Severo
- Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil.
| | - C Schweiger
- Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
| | - D Manica
- Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil
| | - P J C Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil; Unidade de Pneumologia Pediátrica, HCPA, Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007, Porto Alegre, Rio Grande do Sul, Brazil
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Kuhl LP, Marostica PJC, Macedo AJ, Kuhl G, Siebert M, Manica D, Sekine L, Schweiger C. High microbiome variability in pediatric tracheostomy cannulas in patients with similar clinical characteristics. Braz J Otorhinolaryngol 2022; 89:254-263. [PMID: 35680554 PMCID: PMC10071543 DOI: 10.1016/j.bjorl.2022.05.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/03/2022] [Accepted: 05/01/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the bacterial microbiome found in tracheostomy cannulas of a group of children diagnosed with glossoptosis secondary to Robin Sequence (RS), and its clinical implications. METHODS Pediatric patients were enrolled in the study at the time of the cannula change in the hospital. During this procedure, the removed cannula was collected and stored for amplicon sequencing of 16s rRNA. DNA extraction was performed using DNeasy PowerBiofilm Kit (QIAGEN® ‒ Cat nº 24000-50) while sequencing was performed with the S5 (Ion S5™ System, Thermo Fisher Scientific), following Brazilian Microbiome Project (BMP) protocol. RESULTS All 12 patients included in the study were using tracheostomy uncuffed cannulas of the same brand, had tracheostomy performed for over 1-year and had used the removed cannula for approximately 3-months. Most abundant genera found were Aggregatibacter, Pseudomonas, Haemophilus, Neisseria, Staphylococcus, Fusobacterium, Moraxella, Streptococcus, Alloiococcus, and Capnocytophaga. Individual microbiome of each individual was highly variable, not correlating to any particular clinical characteristic. CONCLUSION The microbiome of tracheostomy cannulas is highly variable, even among patients with similar clinical characteristics, making it challenging to determine a standard for normality.
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Affiliation(s)
- Leonardo Palma Kuhl
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia e Cirurgia Cérvico-Facial, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Paulo José Cauduro Marostica
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Alexandre José Macedo
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Farmácia e Centro de Biotecnologia, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia e Cirurgia Cérvico-Facial, Porto Alegre, RS, Brazil
| | - Marina Siebert
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Laboratório de Pesquisa Básica e Avançada em Neurociência (BRAIN), Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Centro de Pesquisa Experimental, Porto Alegre, RS, Brazil
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia e Cirurgia Cérvico-Facial, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | - Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Otorrinolaringologia e Cirurgia Cérvico-Facial, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
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Manica D, Schweiger C. The role of upper airway endoscopy in craniofacial malformations. Semin Fetal Neonatal Med 2021; 26:101293. [PMID: 34561176 DOI: 10.1016/j.siny.2021.101293] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the role of upper airway endoscopy (UAE) in craniofacial malformations in all different management approaches described in the literature. METHODS A narrative review was performed, based on a search in pubmed. RESULTS UAE use was reviewed over five domains: 1) Diagnosis of glossoptosis and endoscopic classification: drug-induced sleep endoscopy is recommended to graduate tongue base obstruction; there is still no consensus on the graduation system to be used. 2) Airway abnormalities: there is a high incidence of additional lesions in conjunction with glossoptosis. 3) Swallowing evaluation: a formal comparison with fluoroscopy (gold standard) has not yet been performed in this population. 4) Intubation: thin bronchoscopes allow intubation of small babies; moreover, intubation with rigid video-assisted laryngoscopes show a high success rate in this population. 5) Treatment outcome monitoring: there is no consensus on the ideal parameters to be checked. CONCLUSION Some approaches have already been well established in the management of patients with craniofacial malformations, e.g. the endocopic evaluation of glossoptosis and associated lesions and its role as an intubation assistance tool, while others need to be subject of further research, e.g. its role in swallowing investigation and as a postoperative success control predictor.
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Affiliation(s)
- Denise Manica
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
| | - Cláudia Schweiger
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
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Schweiger C, Manica D. Acute laryngeal lesions following endotracheal intubation: Risk factors, classification and treatment. Semin Pediatr Surg 2021; 30:151052. [PMID: 34172219 DOI: 10.1016/j.sempedsurg.2021.151052] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Laryngeal stenosis is certainly one of the most severe complications of airway intubation in children, eventually leading to tracheostomy and sometimes to additional surgical procedures. Primary prophylaxis through modification of its risk factors and secondary prophylaxis through the management of post-extubation laryngeal acute lesions seem to be key to avoidance of this fearful complication. The present article addresses known risk factors for the development of laryngeal acute lesions with emphasis on sedation level and intubation time. It also discusses available classification systems proposed in medical literature, especially the Classification of Acute Laryngeal Injuries (CALI) conceived by our research group, and its positive predictive value for the development of chronic lesions. Finally, debate focuses on treatment of each individual lesion. Despite excellent results observed with endoscopic methods for treating these lesions, there is still doubts pending over their management, and there is need for further studies to define adequate treatment for each patient and for each type of lesion.
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Affiliation(s)
- Cláudia Schweiger
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Denise Manica
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Cavalcanti NS, Sekine L, Manica D, Farenzena M, Saleh Neto CDS, Marostica PJC, Schweiger C. Translation and validation of the drooling impact scale questionnaire into Brazilian Portuguese. Braz J Otorhinolaryngol 2020; 88:657-662. [PMID: 33272833 PMCID: PMC9483941 DOI: 10.1016/j.bjorl.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 08/10/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Inadequate drooling can cause serious clinical, functional and social problems. Validated questionnaires to evaluate drooling impact on quality of life are lacking in Brazilian Portuguese. Objectives To translate and validate the drooling impact scale to Brazilian Portuguese. Methods The drooling impact scale was translated to Brazilian Portuguese and back- translated to English to assess potential conceptual differences. Brazilian Portuguese version of drooling impact scale was applied to a 40 patients’ sample of sialorrhea presenting pediatric patients (up to 20 years of age). Chronbach’s alpha, exploratory factorial analysis and confirmatory factorial analysis were then proceeded with data collected. Results The mean drooling impact scale value for the whole population was 51.77 (SD = 16.13). The internal consistency obtained with Cronbach’s alpha indicated a value of 0.72 for the entire sample. The Bartlett’s test of sphericity was significant (p < 0.0001), confirming correlation among variables tested. Kaiser-Meyer-Olkin measure of sampling adequacy revealed a value of 0.72, indicating that the correlation matrix was reasonably suitable for factor analysis. Regarding exploratory factorial analysis, parallel analysis suggested a two-factor solution that was used for confirmatory factorial analysis. The first factor was responsible for 33.78% of the variance with an Eigenvalue of 3.38. The second factor explained 16.1% of the variance with an Eigenvalue of 1.61. At confirmatory factorial analysis, the two-factor model showed consistently better adjustments parameters than the one-factor model. Conclusion The drooling impact scale has been successfully translated to Brazilian Portuguese language, showing adequate internal validity. Validation of this instrument allows physicians and other personnel involved in the care of these patients to perform a better management of patients experiencing drooling. With this tool, we are now able to guide routines and provide guidelines both before and after the different kinds of treatments in order to improve the general well-being of the patient and his family.
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Affiliation(s)
- Natália Silva Cavalcanti
- Hospital de Clínicas de Porto Alegre, Bolsista em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil
| | - Maurício Farenzena
- Hospital de Clínicas de Porto Alegre, Unidade de Radiologia Intervencionista, Porto Alegre, RS, Brazil
| | - Cátia de Souza Saleh Neto
- Hospital de Clínicas de Porto Alegre, Bolsista em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
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Abstract
Background: Following tracheal intubation, some children may develop stridor, which is an indication of an obstructive lesion in the airway, such as an ongoing laryngeal stenosis (LS). This review focuses on evaluation of stridor and possible endoscopic predictors of progression to LS and, once post-intubation acute lesions are established, therapeutic choices to manage this disorder in avoidance of tracheostomy. Tracheostomy, due to its inherent increased morbidity, mortality and influence on social stigma, should be viewed only as a last resort. In this article, available conservative and alternative therapies for ongoing LS are thoroughly reviewed. Methods: A systematic review concerning randomized clinical trials and prospective studies on treatment modalities for LS was performed. A search strategy was developed for MEDLINE comprising terms related to disease, intervention and population. Title and abstract from captured references were peer-reviewed for eligibility. Selected studies full-texts were peer-reviewed and the results were compiled in a structured and narrative review. Stridor evaluation and post-extubation acute lesion classification were studied. Treatments such as balloon dilation, rigid dilation, corticosteroid-coated small tube intubation, and corticosteroid nebulization were described and evidence supporting their usage was discussed.
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Affiliation(s)
- Cláudia Schweiger
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Denise Manica
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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11
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Royer CP, Schweiger C, Manica D, Rabaioli L, Guerra V, Sbruzzi G. Reply – Letter to the editor. Sleep Med 2019; 59:99-100. [DOI: 10.1016/j.sleep.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kiver VII, Wulf-Goldenberg A, Jurmeister PS, Schweiger C, Gorea O, Hoffmann J, Denkert C, Keilholz U, Liedtke C, Blohmer JU. Abstract P6-03-06: Androgen supplementation in patient derived xenografts in androgen receptor positive breast cancer to increase engraftment and growth rate. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-03-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
The European fund for regional development (EFRE) supported Precision Oncology and Personalized Therapy Prediction (POP) Project is establishing preclinical models to further the development of personalized therapy options. In the subgroup breast cancer the current goal is to increase the growth and engraftment rates of breast cancer patient derived xenografts (PDX) models.
Methods:
Breast cancer patients of the Department of Gynecology with Breast Center Charité Universitätsmedizin Berlin, Germany are recruited since May 2017. In total 29 tissue samples were collected and included so far.
Treatment naive and treatment refractory patients, tripple negative breast cancer (TNBC), hormone receptor positive (HR+) and Her2 postivie tumors, primary disease, recurrence or metastasis are sampled. Fresh tumor tissue is extracted via surgery or biopsy. The materials are then implanted into female immunodeficient NOG mice. To establish PDX models for HR+ breast cancer the mice received estrogen supplementation.
To increase engraftment and growth rates androgen receptor (AR) testing and subsequently androgen replacement was started since April 2018.
Up to date, 6 new samples have been collected. One HR+ and two TNBC samples tested also positive for AR. These samples are currently in passage 0 (p0) and are now supplied with androgens to increase engraftment and growth rate. One already established AR+ TNBC PDX is being regrown with androgen supplementation to compare growth rates.
Results:
Out of the initial 23 tissue samples ten (six HR+ and four TNBC) have been able to be engrafted into PDX mice.
The TNBC PDX models are one in p1, one in p2, one in p3 and one is being tested with systemic therapy. Engraftment time in p1 were between 19 and 97 days. Growth time to passagable size between 21 and 112 days.
The HR+ PDX models are four in p1 and two in p2. Engraftment time in p1 was between 26 and 123 days. Growth time to passagable size has been achieved in 2 HR+ PDX within 17 to 48 days.
The engraftment/growth rates and times of the androgen supplemented PDX models will be presented.
Conclusion:
Breast cancer growths in humans slowly and this is also the case in the PDX models. To achieve faster growth and higher engraftment rates androgen supplementation in AR+ breast cancer might be an additional enhancive factor.
Citation Format: Kiver VII, Wulf-Goldenberg A, Jurmeister PS, Schweiger C, Gorea O, Hoffmann J, Denkert C, Keilholz U, Liedtke C, Blohmer J-U. Androgen supplementation in patient derived xenografts in androgen receptor positive breast cancer to increase engraftment and growth rate [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-03-06.
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Affiliation(s)
- VII Kiver
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Wulf-Goldenberg
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - PS Jurmeister
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Schweiger
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - O Gorea
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Hoffmann
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Denkert
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - U Keilholz
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Liedtke
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J-U Blohmer
- Charite Comprehensive Cancer Center, Berlin, Germany; Charite Institute of Gynecology with Breast Center, Berlin, Germany; Charite Institute for Pathology, Berlin, Germany; Experimental Pharmacology & Oncology Berlin GmbH-Berlin-Buch, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Royer CP, Schweiger C, Manica D, Rabaioli L, Guerra V, Sbruzzi G. Efficacy of bilevel ventilatory support in the treatment of stable patients with obesity hypoventilation syndrome: systematic review and meta-analysis. Sleep Med 2018; 53:153-164. [PMID: 30529484 DOI: 10.1016/j.sleep.2018.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/20/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To systematically review the effects of bilevel ventilatory support (BVS) in patients with Obesity Hypoventilation Syndrome (OHS). METHODS A search of databases (MEDLINE accessed by PubMed, Cochrane CENTRAL, EMBASE and LILACS) was conducted from inception to June 2018. Randomized trials comparing BVS to other therapeutic modalities such as lifestyle counseling, continuous positive airway pressure (PAP) or BVS with average volume assured pressure support for the treatment of patients with OHS were included. The primary outcome was a change in daytime arterial carbon dioxide levels (PaCO2). Secondary outcome measures included arterial partial pressure of oxygen (PaO2), blood bicarbonate (HCO3), percentage of total sleep time (TST) with oxygen saturation <90%, transcutaneous pressure of carbon dioxide (PtcCO2), Epworth Sleepiness Scale (ESS), Medical Outcome Survey Short Form (SF36), Functional Outcomes of Sleep Questionnaire (FOSQ), Severe Respiratory Insufficiency Questionnaire (SRI), compliance with treatment, and weight loss. RESULTS Of 176 articles identified, seven studies were included. When BVS was compared to lifestyle counseling, the intervention was superior in improving PaCO2 (-2.90 mmHg; 95%CI -4.28 to -1.52), PaO2 (2.89 mmHg; 95%CI 0.33 to 5.46), HCO3 (-2.55 mmol/L; 95%CI -3.28 to -1.81), percentage of TST<90% (-30.55%; 95%CI -37.98 to -23.12), ESS (-2.52; 95%CI -4.16 to -0.88) and FOSQ (6.33; 95%CI 1.78 to 10.88). However, when BVS was compared to other PAP modalities, there was no difference in any of the outcomes evaluated. CONCLUSIONS Treatment using BVS therapy is superior to lifestyle counseling. Different PAP modalities appear to be equally effective in improving outcomes. CRD42017065326.
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Affiliation(s)
- Caroline Persch Royer
- Postgraduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2 Andar, Porto Alegre, RS, CEP 90035-003, Brazil; Medicine School, Universidade Federal do Rio Grande do Sul: Rua Ramiro Barcelos, 2400/2 Andar, Porto Alegre, RS, CEP 90035-003, Brazil.
| | - Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, CEP 90035-903, Brazil.
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, CEP 90035-903, Brazil.
| | - Luisi Rabaioli
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, CEP 90035-903, Brazil.
| | - Vinicius Guerra
- Postgraduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2 Andar, Porto Alegre, RS, CEP 90035-003, Brazil; Medicine School, Universidade Federal do Rio Grande do Sul: Rua Ramiro Barcelos, 2400/2 Andar, Porto Alegre, RS, CEP 90035-003, Brazil.
| | - Graciele Sbruzzi
- Postgraduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400/2 Andar, Porto Alegre, RS, CEP 90035-003, Brazil; Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, CEP 90035-903, Brazil.
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Manzini M, Schweiger C, Manica D, Machado LR, de Souza Dias Lopes P, Sekine L, Faccin CS, BejzmanPiltcher O, CauduroMarostica PJ. Sinonasal computed tomography in pediatric cystic fibrosis: do we know the indications? Int J Pediatr Otorhinolaryngol 2018; 113:204-207. [PMID: 30173986 DOI: 10.1016/j.ijporl.2018.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigated the correlation between sinonasal computed tomography (SNCT) findings and sinonasal symptoms, genotype, chronic colonization by Pseudomonas aeruginosa, forced expiratory volume in the first second (FEV1), body mass index (BMI), Shwachman-Kulczycki (SK) score, and Bhalla score in patients with cystic fibrosis. METHODS We retrospectively reviewed the medical records of 61 patients aged 2-16 years who received care at the Pediatric Cystic Fibrosis Center of our institution over a 10-year period. SNCT findings were graded using the Lund-Mackay scoring system. For patients who had SNCT scans performed at two different time points, the findings from both examinations were compared. RESULTS Patients with chronic P. aeruginosa colonization and patients with atelectasis had higher Lund-Mackay scores (p = 0.04 and p = 0.01, respectively). There was no difference in Lund-Mackay scores between sinonasal symptomatic and asymptomatic patients (p = 0.45). Among patients who had two SNCT scans available (n = 11), those with no evidence of bronchiectasis on chest CT had decreased Lund-Mackay scores compared to those with evidence of bronchiectasis, who had an increase in their scores (p = 0.03). Variations in the Bhalla score were positively and variations in the SK score were negatively correlated with variations in the Lund-Mackay score (r = 0.74, p = 0.01; and r = -0.85, p < 0.01). CONCLUSIONS Associations between SNCT findings, chronic P. aeruginosa colonization, SK score, and chest CT findings were demonstrated. Further studies with larger sample sizes are needed to evaluate patient follow-up and assess the benefits of the sinonasal treatment strategy adopted for patients who exhibit pulmonary deterioration despite controlling for other factors associated with exacerbation.
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Affiliation(s)
| | | | | | | | | | - Leo Sekine
- Hospital de Clínicas de Porto Alegre, Brazil
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15
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Kiver V, Gambara G, Jurmeister P, Schweiger C, Fuchs K, Gorea O, Burock S, Liedtke C, Karsten M, Bangemann N, Kußmaul J, Hoffmann J, Regenbrecht C, Denkert C, Keilholz U, Blohmer JU. Erfolgreiche Etablierung von präklinischen Brustkrebsmodellen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- V Kiver
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
- Charité Comprehensive Cancer Center, Berlin, Deutschland
| | - G Gambara
- Charité Comprehensive Cancer Center, Berlin, Deutschland
- Deutsches Konsortium für translationale Krebsforschung, Berlin, Deutschland
- Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - P Jurmeister
- Charité Comprehensive Cancer Center, Berlin, Deutschland
- Charité – Universitätsmedizin Berlin, Institut für Pathologie, Berlin, Deutschland
| | - C Schweiger
- Charité Comprehensive Cancer Center, Berlin, Deutschland
- Deutsches Konsortium für translationale Krebsforschung, Berlin, Deutschland
- Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - K Fuchs
- Deutsches Konsortium für translationale Krebsforschung, Berlin, Deutschland
- Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - O Gorea
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
- Charité Comprehensive Cancer Center, Berlin, Deutschland
| | - S Burock
- Charité Comprehensive Cancer Center, Berlin, Deutschland
| | - C Liedtke
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
| | - M Karsten
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
| | - N Bangemann
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
| | - J Kußmaul
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
| | - J Hoffmann
- Experimental Pharmacology &Oncology Berlin GmbH-Buch, Berlin, Deutschland
| | - C Regenbrecht
- cpo – cellular phenomics& oncology Berlin-Buch GmbH, Berlin, Deutschland
| | - C Denkert
- Deutsches Konsortium für translationale Krebsforschung, Berlin, Deutschland
- Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
- Charité – Universitätsmedizin Berlin, Institut für Pathologie, Berlin, Deutschland
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin, Deutschland
- Deutsches Konsortium für translationale Krebsforschung, Berlin, Deutschland
- Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - JU Blohmer
- Charité – Universitätsmedizin Berlin, Campus Mitte, Gynäkologie mit Brustzentrum, Berlin, Deutschland
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16
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Schweiger C, Schleußner E, Groten T. Untersuchung zu prädiktiven Faktoren für das Auftreten eines höhergradigen Dammrisses. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- C Schweiger
- Universitätsklinikum Jena, Klinik für Geburtsmedizin, Jena, Deutschland
| | - E Schleußner
- Universitätsklinikum Jena, Klinik für Geburtsmedizin, Jena, Deutschland
| | - T Groten
- Universitätsklinikum Jena, Klinik für Geburtsmedizin, Jena, Deutschland
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17
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Schweiger C, Hart CK, Tabangin ME, Cohen AP, Roetting NJ, DeMarcantonio M, Becker E, Ward JA, de Alarcón A. Development of a survival animal model for subglottic stenosis. Laryngoscope 2018; 129:989-994. [PMID: 30208212 DOI: 10.1002/lary.27441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop a reproducible survival animal model for subglottic stenosis. STUDY DESIGN Prospective study. METHODS We evaluated five methods of inducing airway injury in 30 New Zealand white rabbits to produce a subglottic stenosis model. Experimental groups comprised: group 1 (n = 5), which underwent 4-hour intubation; group 2 (n = 5), which underwent induced subglottic injury with a nylon brush; group 3 (n = 10), which underwent subglottic injury with a nylon brush, followed by 4-hour intubation; group 4 (n = 5), which underwent subglottic injury with Bugbee cautery in 50% of the subglottic circumference, followed by 4-hour intubation; and group 5 (n = 5), which underwent subglottic injury with Bugbee cautery in 75% of the subglottic circumference, followed by 4-hour intubation. Five animals were used as controls. Endoscopy of the airway and sacrifice of animals were planned at an interval of 14 days postinjury. Histologic measurements were analyzed. RESULTS No animals in groups 1 or 2 developed stenosis. In group 3, 50% of animals developed symptomatic grade 3 subglottic and tracheal stenosis, necessitating early endoscopy and sacrifice in three animals. Four animals in group 4 developed grade 1 subglottic stenosis, and four in group 5 developed grade 2 subglottic stenosis. Histologic measurements of lumen areas within each of these two groups were similar; all animals survived the follow-up period. CONCLUSION We successfully developed a reproducible survival model for induced subglottic stenosis using a combination of cautery-induced subglottic injury followed by 4-hour intubation. This model lays the foundation for future studies that evaluate endoscopic interventions for the management of subglottic stenosis. LEVEL OF EVIDENCE NA Laryngoscope, 129:989-994, 2019.
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Affiliation(s)
- Cláudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Nicholas J Roetting
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Michael DeMarcantonio
- Department of Otolaryngology Head and Neck Surgery, Dwight Eisenhower Army Medical Center, Fort Gordon, Georgia, U.S.A
| | - Elise Becker
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Jonette A Ward
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - Alessandro de Alarcón
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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18
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Eichinger S, Pabinger I, Hartl H, Stain C, Mayerhofer S, Schweiger C, Kier P, Schwarzinger I, Kyrle PA, Lechner K. Azidothymidine (AZT) in the Treatment of Symptomatic HIV-1-Infected Hemophiliacs. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTwenty-one immunodeficiency virus 1 (HIV 1)-positive hemophilic patients were treated with Azidothymidine (AZT) for symptomatic HIV infection. The median observation period was 20.5 months.At 25 months the probability of survival was 82%, the probability of progression of disease from CDC III or IV C2 to IV C1 (AIDS) was 20% in patients on continuous AZT treatment and 50% in patients with intermption of treatment. Three patients developed severe leukopenia and 3 patients severe anemii during AZT treatment. In 1 patient a dose-dependent striking increase of transaminases during AZT treatment was observed. In 7 patients treatment was intermpted, in 1 patient because of anemia, in 1 because of pruritus and in 5 patients because of noncompliance.No signiticant changes in the consumption of clotting factor concentrates and number of bleeding episodes before and during AZT treatment were noted.We conclude, that both hematological and non-hematological side effects of AZT in HIV 1-infected hemophilic patientr ur. comparable to those seen in other risk groups . AzT does not increase the bleeding tendency in this patient group.
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Affiliation(s)
- S Eichinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - I Pabinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - H Hartl
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - C Stain
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - S Mayerhofer
- The First Department of Dermatology, Univeisity of Vienna, Vienna, Austria
| | - C Schweiger
- The Department of Clinical Chemistry, Univeisity of Vienna, Vienna, Austria
| | - P Kier
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - I Schwarzinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - P A Kyrle
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - K Lechner
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
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19
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Wenzel AM, Schweiger C, Manica D, Sekine L, Ferreira ICS, Kuhl G, Marostica PJC. Impact of balloon laryngoplasty on management of acute subglottic stenosis. Eur Arch Otorhinolaryngol 2018; 275:2325-2331. [PMID: 30008140 DOI: 10.1007/s00405-018-5064-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis. METHODS Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later. The other group included children treated initially with balloon laryngoplasty, reflecting a shift in surgical practice after 2009. Data as success of the procedure, mean hospital stay, mean pediatric intensive care unit (PICU) stay, post-procedure fever, need of antibiotics, procedure-related complications, and deaths were assessed and compared between both cohorts. RESULTS The sample comprised 38 pediatric patients aged 0-5 years. Fifteen children were treated before 2009, of who 10 (66.7%) required tracheostomy soon after the diagnosis. Ultimately, 13 (86.6%) underwent laryngotracheal reconstruction. Twenty-three children were treated after 2009 and the success rate in these patients treated primarily with balloon laryngoplasty was 82.6%. Of these, only 3 (13%) required tracheostomy and 1 (4.3%) required further open laryngotracheal reconstruction. Patients treated by balloon laryngoplasty underwent fewer procedures under general anesthesia and had a lower burden of treatment-related morbidity, as denoted by shorter PICU stay, less antibiotic use, earlier postoperative resumption of oral feeding, and a lower incidence of postoperative complications and fever. CONCLUSION When used for management of acute laryngeal stenosis, balloon laryngoplasty is associated with a high success rate, presenting lower morbidity than open surgery.
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Affiliation(s)
- Andréia Melchiors Wenzel
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Denise Manica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Isabel Cristina Schütz Ferreira
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Pediatric Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Pediatric Pulmonology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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da Costa AL, Manica D, Schweiger C, Kuhl G, Sekine L, Fagondes SC, Collares MV, Cauduro Marostica PJ. The effect of mandibular distraction osteogenesis on airway obstruction and polysomnographic parameters in children with Robin sequence. J Craniomaxillofac Surg 2018; 46:1343-1347. [PMID: 29861406 DOI: 10.1016/j.jcms.2018.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/16/2018] [Accepted: 05/11/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy. OBJECTIVES To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO. METHODS In this prospective cohort study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography. RESULTS Patients' symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05). CONCLUSIONS MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters.
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Affiliation(s)
- Amanda Lucas da Costa
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - Gabriel Kuhl
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil; Department of Ophthalmology and Otolaryngology, UFRGS, Rua Ramiro Barcelos, 2400, 90035-903, Porto Alegre, RS, Brazil.
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia, UFRGS, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil.
| | | | | | - Paulo Jose Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Pediatric Pulmonology Unit, HCPA, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
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Schweiger C, Schleußner E, Groten T. Untersuchung zu prädiktiven Faktoren für das Auftreten eines höhergradigen Dammrisses. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- C Schweiger
- Klinik für Geburtsmedizin, Universitätsklinikum Jena
| | - E Schleußner
- Klinik für Geburtsmedizin, Universitätsklinikum Jena
| | - T Groten
- Klinik für Geburtsmedizin, Universitätsklinikum Jena
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Manica D, Schweiger C, Sekine L, Fagondes SC, Kuhl G, Vinicius Collares M, Marostica PJC. Diagnostic accuracy of current glossoptosis classification systems: A nested cohort cross-sectional study. Laryngoscope 2017; 128:502-508. [DOI: 10.1002/lary.26882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/11/2017] [Accepted: 08/03/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Denise Manica
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Cláudia Schweiger
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Simone Chaves Fagondes
- Department of Pulmonology; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Gabriel Kuhl
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Marcus Vinicius Collares
- Department of Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Paulo José Cauduro Marostica
- Department of Pediatric Pulmonology; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
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Avelino MAG, Maunsell R, Valera FCP, Lubianca Neto JF, Schweiger C, Miura CS, Chen VG, Manrique D, Oliveira R, Gavazzoni F, Picinin IFDM, Bittencourt P, Camargos P, Peixoto F, Brandão MB, Sih TM, Anselmo-Lima WT. First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP). Braz J Otorhinolaryngol 2017; 83:498-506. [PMID: 28807655 PMCID: PMC9444758 DOI: 10.1016/j.bjorl.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction Tracheostomy is a procedure that can be performed in any age group, including children under 1 year of age. Unfortunately health professionals in Brazil have great difficulty dealing with this condition due to the lack of standard care orientation. Objective This clinical consensus by Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) and Sociedade Brasileira de Pediatria (SBP) aims to generate national recommendations on the care concerning tracheostomized children. Methods A group of experts experienced in pediatric tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pediatric pulmonologists) were selected, taking into account the different regions of Brazil and following inclusion and exclusion criteria. Results The results generated from this document were based on the agreement of the majority of participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation. Conclusion These guidelines can be used as directives for a wide range of health professionals across the country that deal with tracheostomized children.
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Affiliation(s)
- Melissa A G Avelino
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil; Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil; Pontifícia Universidade Católica de Goiás (PUC-GO), Goiânia, GO, Brazil; Universidade Federal de Goiás (UFG), Hospital das Clínicas, Unidade de Cabeça e Pescoço, Goiânia, GO, Brazil.
| | - Rebecca Maunsell
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Oftalmo/Otorrinolaringologia, Campinas, SP, Brazil
| | - Fabiana Cardoso Pereira Valera
- Universidade São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Cláudia Schweiger
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carolina Sponchiado Miura
- Universidade São Paulo (USP), Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Vitor Guo Chen
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Dayse Manrique
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil; Associação de Assistência a Criança Deficiente (AACD), Clínica de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | | | - Isabela Furtado de Mendonça Picinin
- Serviço de Assistência Integral à Criança Traqueostomizada (SAIT), Belo Horizonte, MG, Brazil; Universidade José do Rosário Vellano (UNIFENAS), Curso de Medicina, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas (HC), Pneumologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Paulo Bittencourt
- Serviço de Assistência Integral à Criança Traqueostomizada (SAIT), Belo Horizonte, MG, Brazil
| | - Paulo Camargos
- Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas (HC), Pneumologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Fernanda Peixoto
- Universidade Federal de Goiás (UFG), Unidade de Terapia Intensiva, Goiânia, GO, Brazil
| | - Marcelo Barciela Brandão
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Tania Maria Sih
- Universidade de São Paulo (FMUSP), Faculdade de Medicina, São Paulo, SP, Brazil; International Society for Otitis Media (ISOM), São Paulo, SP, Brazil
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Schweiger C, Manica D, Pereira DRR, Carvalho PRA, Piva JP, Kuhl G, Sekine L, Marostica PJC. Undersedation is a risk factor for the development of subglottic stenosis in intubated children. J Pediatr (Rio J) 2017; 93:351-355. [PMID: 28130966 DOI: 10.1016/j.jped.2016.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/25/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. METHODS All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. RESULTS The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p=0.004). CONCLUSION Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.
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Affiliation(s)
- Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Denise Rotta Rutkay Pereira
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Paulo Roberto Antonacci Carvalho
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, Brazil
| | - Jefferson Pedro Piva
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Otorrinolaringologia e Oftalmologia, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
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Abstract
Although suprastomal granulomas are a common complication of tracheotomy, they usually are an incidental finding and do not always require treatment. However, large granulomas may require removal, either to assist with speech production or to make the airway safer in the event of an accidental decannulation. Very large suprastomal granulomas extending up to or even through the vocal cords have been described. However, inverting suprastomal granulomas extending distally down the length of a tracheotomy tube have not been previously described. We present two cases of large suprastomal granulomas that extended distally down the trachea. Both extended beyond the tip of the tracheotomy tube, causing partial airway obstruction, and therefore required excision. Laryngoscope, 127:2883-2885, 2017.
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Affiliation(s)
- Cláudia Schweiger
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Robin T Cotton
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Manica D, de Souza Saleh Netto C, Schweiger C, Sekine L, Enéas LV, Pereira DR, Kuhl G, Carvalho PRA, Marostica PJC. Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children. Eur Arch Otorhinolaryngol 2017; 274:2871-2876. [PMID: 28439690 DOI: 10.1007/s00405-017-4574-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.
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Affiliation(s)
- Denise Manica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil. .,Otolaryngology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Catia de Souza Saleh Netto
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil.,Otolaryngology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Larissa Valency Enéas
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Denise Rotta Pereira
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Gabriel Kuhl
- Otolaryngology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Paulo Roberto Antonacci Carvalho
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-903, Brazil
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Manica D, Sekine L, Abreu LS, Manzini M, Rabaioli L, Valério MM, Oliveira MP, Bergamaschi JA, Fernandes LA, Kuhl G, Schweiger C. Influence of dietary and physical activity restriction on pediatric adenotonsillectomy postoperative care in Brazil: a randomized clinical trial. Braz J Otorhinolaryngol 2017; 84:191-195. [PMID: 28320603 PMCID: PMC9449230 DOI: 10.1016/j.bjorl.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/15/2017] [Accepted: 01/27/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Although culturally food and physical activity restriction are part of the routine postoperative care of many Brazilian surgeons, current evidences from other countries support no such recommendations. Objective To determine whether dietary and physical restriction effectively lead to a decrease on postoperative complications of adenotonsillectomy in children when compared to no restriction. Methods We have designed a randomized clinical trial comparing two intervention: no specific counseling on diet or activity (Group A), and restriction recommendations on diet and physical activities (Group B). Caregivers completed a questionnaire on observed pain, diet and activity patterns, and medications administered. Parameters were compared at the 3rd and at the 7th postoperative day between intervention groups. Results We have enrolled a total of 95 patients, 50 in Group A and 45 in Group B. Fourteen patients were lost to follow up. Eventually, 41 patients in group A and 40 in Group B were available for final analysis. Mean age in months (A = 79.5; SD = 33.9/B = 81.1; SD = 32.6) and sex (A = 58% male; B = 64.4% male) were equivalent between groups. Pain, evaluated through visual analog scale in the 3rd (A = 2.0; IQR 1–6/B = 4.5; IQR 2–6; p = 0.18) and in the 7th (A = 1.0; IQR 1.0–4.5/B = 2.0; IQR 1.0–4.7; p = 0.29) postoperative days, was not different between groups, as was the amount of analgesics administered. Dietary and physical activity patterns also showed no statistically significant differences between groups. Conclusion Dietary and activity restriction after adenotonsillectomy does not seem to affect patients’ recovery. Such information may impact considerably on the social aspects that involve a tonsillectomy, reducing the working days lost by parents and accelerating the return of children to school.
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Affiliation(s)
- Denise Manica
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Leo Sekine
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Larissa S Abreu
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Luísi Rabaioli
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | | | | | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Gasparin M, Schweiger C, Manica D, Maciel AC, Kuhl G, Levy DS, Marostica PJC. Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis. Pediatr Pulmonol 2017; 52:41-47. [PMID: 27228428 DOI: 10.1002/ppul.23484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/03/2016] [Accepted: 05/06/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the accuracy of clinical evaluation of swallowing in a sample of children with laryngomalacia or glossoptosis and describe the prevalence of dysphagia in each of these diseases, as well as characterize the swallow response to speech and language therapy interventions. STUDY DESIGN Children aged 1 month to 11 years receiving care at the Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Brazil, were evaluated in a cross-sectional design. Evaluation of swallowing was performed at two time points by two blinded speech-language pathologists, one responsible for clinical evaluation and the other for videofluoroscopic study. The protocols employed were based on the instruments proposed by DeMatteo et al. (DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.). RESULTS The study sample consisted of 29 patients: 10 patients with laryngomalacia and 19 patients with glossoptosis. The sensitivity of clinical evaluation did not exceed 50% in any of the evaluations, but specificity reached 100% in some cases, using thickened liquids. The prevalence of dysphagia was 100%, and the use of thickened liquids significantly reduced tracheal aspiration. CONCLUSIONS Dysphagia was highly prevalent in this sample. The sensitivity of clinical evaluation to detect laryngeal penetration and tracheal aspiration was low, as the majority of aspiration events were silent. The videofluoroscopic study is important in order to determine a safest method to feed the patient. Pediatr Pulmonol. 2017;52:41-47. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marisa Gasparin
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcellos, 2400, Porto Alegre 90035-003, RS, Brazil
| | - Cláudia Schweiger
- Laryngology Unit, Department of Otolaryngology, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, School of Medicine, UFRGS, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Denise Manica
- Laryngology Unit, Department of Otolaryngology, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, School of Medicine, UFRGS, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Antônio Carlos Maciel
- Department of Radiology, HCPA, Universidade Federal do Rio de Janeiro (UFRJ), Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Department of Otolaryngology, HCPA, Porto Alegre, RS, Brazil
| | - Deborah Salle Levy
- School of Speech-Language Pathology and Audiology, UFRGS, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Pediatric Pulmonology Unit, Department of Pediatrics, HCPA, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, School of Medicine, UFRGS, Porto Alegre, RS, Brazil
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Manica D, Schweiger C, Sekine L, Fagondes SC, Gasparin M, Levy DS, Kuhl G, Collares MV, Marostica PJC. Severity of clinical manifestations and laryngeal exposure difficulty predicted by glossoptosis endoscopic grades in Robin sequence patients. Int J Pediatr Otorhinolaryngol 2016; 90:270-275. [PMID: 27729147 DOI: 10.1016/j.ijporl.2016.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients. SETTING Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA). PATIENTS All RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS. INTERVENTION Patients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification. MAIN OUTCOME MEASURE Association between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty. RESULTS Twenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05). CONCLUSION Patients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.
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Affiliation(s)
- Denise Manica
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Cláudia Schweiger
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marisa Gasparin
- Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Gabriel Kuhl
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcus Vinicius Collares
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Pediatric Pneumology Department, Hospital de Clínicas de Porto Alegre, Brazil
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Schweiger C, Manica D, Becker CF, Abreu LSP, Manzini M, Sekine L, Kuhl G. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil. Braz J Otorhinolaryngol 2016; 83:627-632. [PMID: 27599810 PMCID: PMC9449076 DOI: 10.1016/j.bjorl.2016.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/01/2016] [Accepted: 08/10/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. OBJECTIVE To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. METHODS Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. RESULTS 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). CONCLUSION Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.
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Affiliation(s)
- Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Carolina Fischer Becker
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | | | - Michelle Manzini
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
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Schweiger C, Manica D, Kuhl G, Sekine L, Marostica PJC. Post-intubation acute laryngeal injuries in infants and children: A new classification system. Int J Pediatr Otorhinolaryngol 2016; 86:177-82. [PMID: 27260603 DOI: 10.1016/j.ijporl.2016.04.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/23/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the Classification of Acute Laryngeal Injuries (CALI) with other classifications to determine which of these offers the greatest sensitivity and specificity in predicting the development of subglottic stenosis. METHODS All children intubated for the first time in the pediatric intensive care unit were included and subjected to flexible fiber-optic laryngoscopy (FFL) within 8 h of extubation. Their injuries were categorized using the CALI, as well as adapted classifications from Lindholm, Colice and Benjamin. The children were followed up to determine who developed subglottic stenosis. RESULTS This study included 194 children, with a median age of 2.67 months. The sensitivity and specificity of the CALI were 90% and 73%, respectively. The CALI showed greater specificity than the adapted classifications from Colice and Benjamin (p < 0.001 for both), and greater sensitivity than the adapted classification from Lindholm (p < 0.001). CONCLUSIONS Based on the CALI, 90% of children who developed subglottic stenosis had moderate to severe injuries on the initial FFL. The CALI includes all injury types described by Benjamin, as well as a proposed severity scale for these lesions, and was predictive of the development of chronic laryngeal injury.
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Affiliation(s)
- Cláudia Schweiger
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Denise Manica
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriel Kuhl
- Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Ophtalmology and Otolaryngology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Manzini M, Schweiger C, Manica D, Kuhl G. Response to OK-432 sclerotherapy in the treatment of cervical lymphangioma with submucosal extension to the airway. Braz J Otorhinolaryngol 2016; 86:127-129. [PMID: 27297957 PMCID: PMC9422381 DOI: 10.1016/j.bjorl.2016.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 04/11/2016] [Accepted: 04/15/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michelle Manzini
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Abstract
Glossoptosis causes varying degrees of airway obstruction and feeding difficulties. It can occur as a consequence of micrognathia in Robin Sequence, but can also occur in children with hypotonia. Despite several attempts to classify severity in Robin Sequence patients, taking into account symptoms, presence of concomitant syndromes or malformations, and even endoscopic findings, there is still no general consensus. Furthermore, several management recommendations have been reported without an agreement about indications, efficacy, or risks of each treatment option. The present article provides an overview of clinical presentation, diagnosis, management, and prognosis of patients with glossoptosis.
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Affiliation(s)
- Cláudia Schweiger
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-903, Porto Alegre, Brazil.
| | - Denise Manica
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-903, Porto Alegre, Brazil
| | - Gabriel Kuhl
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Beyer J, Jäger Y, Balci D, Weschenfelder F, Schweiger C, Seeger S, Schlembach D, Abou-Dakn M, Schleußner E. Vergleich der Geburtseinleitungen mit Misodel® vs. Cytotec® vs. Propess®. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schweiger C, Schneider U, Beyer J, Voigt C, Wolke S, Liebers N, Fiedler A, Faber R. Schwierigkeit der pränatalen Differentialdiagnostik zwischen VACTERL und kaudaler Regressionssequenz (cRS) bei Ösophagusatresie Typ IIIb. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manica D, Neto CS, Schweiger C, Cortina M, Kuhl G. Dermoid of the nasopharynx causing neonatal respiratory distress. Int Arch Otorhinolaryngol 2015; 17:407-8. [PMID: 25992046 PMCID: PMC4399178 DOI: 10.1055/s-0033-1351677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/28/2012] [Indexed: 11/03/2022] Open
Abstract
The dermoid is a rare and benign malformation of bigerminal origin. It is seen frequently in the neonatal period, and the clinical presentation depends on the site and on the size of the lesion, and the classical clinical picture is of a tumor derived from the naso- or oropharynx, leading to respiratory distress and/or feeding disorders. A female newborn was born cyanotic requiring intubation. The oroscopy revealed a large smooth mass. Transoral surgery was performed with successful extubation. Seven months after, there are no signs of recurrence of the lesion. This report adds another case of this rare pathology that can be life-threatening condition in the neonate. It emphasizes the importance of dermoid in the differential diagnosis of the naso- or oropharyngeal lesions, especially in neonates.
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Affiliation(s)
- Denise Manica
- Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre/RS, Brazil ; Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brazil
| | - Cátia Saleh Neto
- Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre/RS, Brazil ; Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brazil
| | - Cláudia Schweiger
- Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre/RS, Brazil ; Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brazil
| | - Marcelo Cortina
- Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre/RS, Brazil
| | - Gabriel Kuhl
- Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre/RS, Brazil ; Universidade Federal do Rio Grande do Sul, Porto Alegre/RS, Brazil
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Collares MVM, Tovo AHS, Duarte DW, Schweiger C, Fraga MM. Novel treatment of neonates with congenital nasal pyriform aperture stenosis. Laryngoscope 2015; 125:2816-9. [PMID: 25684725 DOI: 10.1002/lary.25198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/14/2014] [Accepted: 01/15/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Marcus Vinicius Martins Collares
- Division of Plastic and Craniomaxillofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Hanke Stern Tovo
- Division of Plastic and Craniomaxillofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Daniele Walter Duarte
- Division of Plastic and Craniomaxillofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cláudia Schweiger
- Department of Otorhinolaryngology/Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mariana Miguel Fraga
- Division of Plastic and Craniomaxillofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Abreu L, Becker C, Schweiger C, Manica D, Kuhl G, Marostica P. Balloon Laryngoplasty for Pediatric Laryngeal Stenosis: Experience in 18 Cases. Int Arch Otorhinolaryngol 2014. [DOI: 10.1055/s-0034-1388687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bauer J, Becker C, Schweiger C, Kuhl G, Deutsch K, Manzini M. Laryngeal Cellular Neurothekeoma: First Case Report. Int Arch Otorhinolaryngol 2014. [DOI: 10.1055/s-0034-1388874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Manica D, Schweiger C, Netto CCS, Kuhl G. Retrospective study of a series of choanal atresia patients. Int Arch Otorhinolaryngol 2013; 18:2-5. [PMID: 25992054 PMCID: PMC4296943 DOI: 10.1055/s-0033-1358581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 07/23/2013] [Indexed: 11/27/2022] Open
Abstract
Introduction Although it has been more than 250 years since the first description of choanal atresia (CA), there are still doubts about this abnormality. The differences between unilateral and bilateral forms are seldom discussed. Objectives Aggregate data from patients diagnosed with CA, grouping patients with unilateral and bilateral forms. Methods Retrospective study. Results Eighteen patients were included: 12 (66.6%) presented bilateral atresia, of which 77.8% were mixed bony-membranous type and 22.2% were pure bony type. From the 12 patients with bilateral atresia, 10 presented related malformations, 3 of whom had CHARGE syndrome (coloboma, heart defects, choanal atresia, retardation of growth and development, genitourinary problems, ear abnormalities). From the remaining 6 patients with unilateral atresia, only 2 showed malformations, 1 renal and 1 cardiac. All patients with unilateral atresia needed only 1 surgical procedure, and patients with the bilateral form needed a median of 2.85 interventions (p = 0.003). The median age of surgical procedure in the unilateral group was 6 years, ranging from 6 months to 18 years, and in the bilateral group was 25 days, ranging from 6 days to 6 years (p = 0.003). The median interval between diagnosis and surgery was 9 months in the unilateral group, ranging from 1 month to 18 years, and in the bilateral group was 1 day, ranging from 1 day to 2 months (p = 0.001). Discussion and Conclusions Success rates with the endoscopic approach vary from 62 to 100%. Nonetheless, most of these reports present results without considering the number of compromised sides. In our opinion, unilateral and bilateral cases involve distinct patients (taking into account the related malformations), have diverging clinical presentations, and show discrepant restenosis rates and therefore could be considered in different groups of analysis.
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Affiliation(s)
- Denise Manica
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil ; Serviço de Otorrinolaringologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil ; Serviço de Otorrinolaringologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cátia C Saleh Netto
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil ; Serviço de Otorrinolaringologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil ; Serviço de Otorrinolaringologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Manica D, Schweiger C, Maróstica PJC, Kuhl G, Carvalho PRA. Association Between Length of Intubation and Subglottic Stenosis in Children. Laryngoscope 2013; 123:1049-54. [DOI: 10.1002/lary.23771] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2012] [Indexed: 11/11/2022]
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Lampl C, Haider B, Schweiger C. Long-term efficacy of Boswellia serrata in 4 patients with chronic cluster headache. J Headache Pain 2013. [DOI: 10.1186/1129-2377-1-s1-p37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Smith MM, Schweiger C, Manica D, Meotti CD, Eneas LV, Kuhl G, Marostica PJC. Single-stage laryngotracheal reconstruction for the treatment of subglottic stenosis in children. Int Arch Otorhinolaryngol 2012; 16:217-21. [PMID: 25991938 PMCID: PMC4432553 DOI: 10.7162/s1809-97772012000200010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/12/2011] [Indexed: 11/16/2022] Open
Abstract
Introduction: In recent decades, airway reconstruction has become the treatment of choice for subglottic stenosis (SGS) in children, which is performed in either single or multiple stages. However, there is evidence in the literature that single-stage surgery is more effective. Objective: To evaluate the success rate of single-stage laryngotracheoplasty (LTP) and cricotracheal resection (CTR) in patients that were treated in our hospital. Materials and Method: We performed a retrospective study of children undergoing laryngotracheal reconstruction. Results: Twenty-four children were included. The etiology of SGS was postintubation in 91.6% and congenital in 8.3%. One patient (4.2%) had grade 4 SGS, 17 (70.8%) presented with grade 3 SGS, 4 (16.6%) had grade 2 SGS, 1 (4.2%) had grade 3 SGS associated with glottic stenosis, and 1 (4.2%) had grade 3 SGS with tracheal stenosis. We performed 26 LTPs and 3 CTRs. Decannulation rates were 66% in the CTR procedures and 85.7% in the LTP procedures; the overall decannulation rate was 83.3%. All children presented with fever in the postoperative period, but were afebrile after the tube was removed. Conclusion: Our series showed a decannulation rate of 83.3%.
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Affiliation(s)
- Mariana Magnus Smith
- Master. Medical Residency Preceptor of Otolaryngology of Hospital São Lucas of PUCRS / Sao Lucas Hospital of PUC/RS - Catholic University, Rio Grande do Sul State, Brazil
| | - Cláudia Schweiger
- Master. Medical Residency Preceptor of Otolaryngology of Hospital de Clínicas of Porto Alegre/Clinical Hospital of Porto Alegre, Rio Grande do Sul State, Brazil
| | - Denise Manica
- Otolaryngologist. Fellowship in Laryngology of Hospital de Clínicas of Porto Alegre/ Clinical Hospital of Porto Alegre, Rio Grande do Sul State, Brazil
| | - Camila Degen Meotti
- Otolaryngologist. Fellowship em Rhinology of Hospital de Clínicas of Porto Alegre/ Clinical Hospital of Porto Alegre, Rio Grande do Sul State, Brazil
| | - Larissa Valency Eneas
- Otolaryngologist. Medical Residency Preceptor of Otolaryngology of Hospital São Lucas of PUCRS/ Sao Lucas Hospital of PUC/RS - Catholic University, Rio Grande Do Sul State, Brazil
| | - Gabriel Kuhl
- Otolaryngologist. Professor of Otolaryngology and Ophthalmology Department of UFRGS. Medical Residency Preceptor of Otolaryngology of HCPA- Clinical Hospital of Porto Alegre
| | - Paulo Jose Cauduro Marostica
- Post-Ph.D. Professor of Pediatrics Department of UFRGS - Federal University of Rio Grande do Sul State. Medical Residency Preceptor of Pediatrics of HCPA - Clinical Hospital of Porto Alegre
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Manica D, Schweiger C, Silva DBE, Smith MM, Kuhl G. Laryngotracheoplasty in a low birth weight preterm newborn. Braz J Otorhinolaryngol 2012; 78:140. [PMID: 22392252 PMCID: PMC9443888 DOI: 10.1590/s1808-86942012000100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Manica D, Schweiger C, Saleh Netto C, Kuhl G. RETROSPECTIVE STUDY OF A SERIES OF PATIENTS WITH CHOANAE ATRESIA. Int Arch Otorhinolaryngol 2012. [DOI: 10.7162/s1809-9777201200s1o-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Vollmer TC, Wittmann M, Schweiger C, Hiddemann W. Preoccupation with death as predictor of psychological distress in patients with haematologic malignancies. Eur J Cancer Care (Engl) 2011; 20:403-11. [PMID: 20597956 DOI: 10.1111/j.1365-2354.2010.01203.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the present study was to identify preoccupation with death in relation to levels of psychological distress in patients with haematologic malignancies. One hundred and two inpatients with haematologic malignancies, treated with curative intent, and thirty-three control inpatients with benign dysfunction participated in the present study. Psychological distress was measured with the Hospital Anxiety and Depression Scale and the Freiburg Questionnaire of Coping with Illness. Preoccupation with death was assessed with the Subjective Estimation of Sickness and Death Scale. Patients with haematologic malignancies had significantly more preoccupation with death than the control group. In patients with haematologic malignancies preoccupation with death was related to depressive coping style as well as symptoms of depression and anxiety; regression analyses reveal that the diagnosis of haematologic malignancy leads to stronger subjective feelings of being close to death, which in turn leads to more psychological distress. To the best of our knowledge this is the first study that quantitatively shows the existence of preoccupation with death in patients with haematologic malignancies and its association with psychological distress. Our findings indicate that patients who are treated with a curative regime need psychological intervention focusing on death-related fear in order to prevent severe emotional distress.
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Affiliation(s)
- T C Vollmer
- Institute of Applied Psychology in Architecture and Health, Rotterdam, The Netherlands.
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Schweiger C, Gil P, Parak W, Kissel T. MRI contrast enhancement potential of different superparamagnetic iron oxide nanoparticle (SPION) formulations. J Control Release 2010; 148:e67-8. [DOI: 10.1016/j.jconrel.2010.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dornelles C, Meurer L, Selaimen da Costa S, Schweiger C. Histologic description of acquired cholesteatomas: comparison between children and adults. Braz J Otorhinolaryngol 2007; 72:641-8. [PMID: 17221056 PMCID: PMC9443531 DOI: 10.1016/s1808-8694(15)31020-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 06/23/2005] [Indexed: 11/16/2022] Open
Abstract
Cholesteatoma is constituted of matrix, perimatrix and cystic content. Some authors affirm that, in children, its clinical behavior is more aggressive of the than in adults. Aims Histologic compared cholesteatomas of children and adults. Methodology 74 cholesteatomas been analyzed, being 35 of pediatrics patients (<18 years). The average number of cellular layers and hyperplasia in the matrix had been evaluated; thickness, delimitante epithelium, fibrosis, inflammation and granuloma in the perimatrix. The analysis statistics was carried through with program SPSS 10,0, using the coefficients of Pearson and Spearman, test of qui-square and t test. The number of cellular layers in the matrix was of 8,2±4,2. The hyperplasia appears in 17%, fibrosis in 65%, granuloma in 12% and the delimitante epithelium in 21%. The perimatrix presented a medium one of 80 micrometers (37 the 232), minimum value zero and maximum value 1.926. The histological degree of inflammation was considered of moderate the accented one in 60%. When applying the coefficient of Spearman enters the inflammation degree and average of cellular layers of the matrix with the variables of the measure of thickness of the perimatrix we find correlations, significant, with moderate magnitudes of the great ones (rs=0,5 and P<0,0001). Conclusion Adults colesteatomas of and child had not been identified to morphologic differences between. We find correlation enters the intensity of the inflammation and of the average of cellular layers of the matrix with the thickness of the perimatrix, what it can predict its aggressiveness, more studies are necessary to define the paper of this finding in pathogenesis of cholesteatoma.
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Affiliation(s)
- Cristina Dornelles
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, University Hospital of Porto Alegre, Brazil
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Piltcher OB, Antunes M, Monteiro F, Schweiger C, Schatkin B. Is there a reason for performing frontal sinus trephination at 1 cm from midline? A tomographic study. Braz J Otorhinolaryngol 2007; 72:505-7. [PMID: 17143429 PMCID: PMC9445702 DOI: 10.1016/s1808-8694(15)30996-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2005] [Accepted: 04/25/2006] [Indexed: 11/18/2022] Open
Abstract
The complex anatomy of the frontoethmoidal recess, as well as its anatomical relationship with the vital adjacent structures in the region explain the reason for considerable surgical care to protect these structures and minimize complications related to healing. Trephination is an accepted procedure to access the frontal sinus. Aim Discuss the best location for performing frontal sinus trephination. Methods Measuring sinus frontal depth at 3 points equidistant to the midline (crista galli) through the axial tomographic sections. Results We measured 138 frontal sinus (69 patients). Frontal sinus depth at 0,5 cm was statistically larger than 1 cm and 1,5 cm, as well as the 1 cm trephine point was significantly larger than 1,5 cm (12,22±4,25 vs 11,78±4,65 p<0,05; 12,22±4,25 vs 10,78±5,98 p<0,001; 11,78±4,65 vs 10,78±5,98 p<0,05). The trephine set used (maximum depth of penetration of 0,7 cm) is safe to be applied in approximately 80% of the patients. Conclusion Analizing the results, the trephination may be performed at variable points of the frontalsinus, but the distance of 1 cm from midline appears to be safer and shows better aestethic results.
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