- Email: [email protected]
Cricoid split for subglottic stenosis in infancy
942
INTERNATIONAL ABSTRACTS
Neurogenic Pulmonary Oedema Precipitated by Induction of Anaesthesia. N. Braude and T. Ludgrove. Br J Anaesth 62:101-103,
Eosinophilic Granulomatous Lymphadenopathy: Association With Hyper IgE and Eosinophilia. C. Kaplinksy, C. Mor, l.J. Cohen, et al.
(January), 1989.
Pediatr Pathol, 8:377-384, 1988.
A 12-year-old boy with spina bifida and hydrocephalus was admitted with a disconnected ventricular shunt but no evidence of raised intracranial pressure, although he was complaining of headaches and nausea. Shortly after induction the child developed pulmonary oedema. It is postulated that the pressor response of intubation, intermittent positive pressure ventilation through a Magill circuit, and the early induction of halothane produced a critical increase in intra-cranial pressure which, together with the presence of an Arnold-Chiari malformation, precipitated a fulminant form of neurogenic pulmonary oedema (NPO). The author suggests that prevention of NPO in this patient may have been possible by attenuating the intubation-related increase in intracranial pressure by pre-treatment with intravenous lignocaine, the use of a nondepolarizing neuromuscular blocking drug, and ventilation with more efficient circuit.--Ray J. Fitzgerald
Two cases of cervical lymphadenopathy in children associated with hyper-IgE and eosinophilia are described which revealed the features of necrotizing eosinophilic granulomatosis. Immunohistochemical analysis and serologic work-up failed to identify an underlying cause. Central necrosis was an identifying factor. This lesion is differentiated from the fatal form of necrotizing eosinophilic granulomatosis by its association with eosinophilia and hyperIgE.--Eugene S. Wiener
HEAD A N D NECK Cricoid Split for Subglottic Stenosis in Infancy. B.A. Michna, T.M.
Krummel, T. Tracy, Jr, et al. Ann Thorac Surg 45:541-543, (May) 1988. Four infants with subglottic stenosis (three acquired and one congenital) were treated with the anterior cricoid split procedure. The technique and postoperative care are described. Tracheostomy was prevented, and all infants were extubated within 22 days of the procedure. One infant developed an epithelial cyst of the trachea that required surgical management 6 months after cricoid split. Follow-up at from 18 to 24 months demonstrated airway patency and the absence of stridor. The anterior cricoid split can be successfully used to treat subglottic stenosis in a selected group of patients. Marleta Reynolds External Fistula of the Main Parotid Duct; The Alternative Procedure. W, Perdzynski, Z.H. Kalicinski, and T. Bokwa. Z Kinderchir
43:417-418, (December), 1988. The authors present a boy with external fistula of the parotid duct. Treatment consisted of ellipsoid skin incision surrounding the external orifice. After creation of a canal through the cheek, the orifice of the duct was pulled into the oral cavity and sutured to the mucosa. The result was satisfactory without signs of dilatation or cyst formation.--Thomas A. Angerpointer High Resolution Ultrasonography of the Parotid Gland in Children.
Part II. R.W. Seibert and J.J. Seibert. Pediatr Radiol 19:13-18, (November), 1988.
The authors have previously reported a technique for visualizing the parotid gland with high resolution ultrasonography. The fine morphology of the parotid gland as well as normal anatomical landmarks were well visualized with ultrasonography. This study has continued for the past 2 years, and an additional 20 patients with suspected parotid pathology are presented. Ultrasound was helpful in (1) making a specific diagnosis in sialectasis, (2) determining whether parotid swelling was secondary to enlargement of adjacent tissues or indeed secondary to an intraparotid mass, (3) demonstrating whether enlargement of adjacent tissues was vascular by using duplex Doppler scanning, and (4) follow-up of enlarged nodes within the parotid and adjacent to the parotid for development of abscess formation.--Prem Purl
HEART A N D GREAT VESSELS Spontaneous Aortic Thrombosis in a Neonate Presenting as
Coaretation. R.M. Hamilton, P.A. Penkoske, P. Byrne, et al. Ann Thorac Surg 45:564-565, (May), 1988.
Aortic thrombosis in a neonate usually involves the abdominal aorta and is secondary to umbilical artery catheterization. Medical management of this complication has been successful. Spontaneous thrombosis of the thoracic aorta successfully treated with thrombectomy has not been previously reported. This case report describes a newborn infant with clinical signs and symptoms of a critical coarctation of the aorta. Echocardiography demonstrated complete narrowing of the aorta just above the level of a persistent duetus arteriosus. Cardiac catheterization demonstrated the thrombus. At surgery, the thrombus was removed and the aorta patched with Gore-tex. The authors cite the advantage of surgical thrombeetomy over medical management in obtaining immediate relief of the obstruction.--Marleta Reynolds Pulmonary Artery Sling With Tracheal Stenosis: One Staged
Repair. M.St.J. Hickey, and A.E. Wood. Ann Thorac Surg 44:416417, (October), 1987.
Tracheal pathology is often associated with pulmonary artery sling. This case report describes the one stage repair of an infant with pulmonary artery sling and four complete tracheal rings using cardiopulmonary bypass. Preoperative bronehoscopy had demonstrated the severe tracheal pathology. The rings were resected and the trachea repaired primarily. An atrial septal defect was repaired simultaneously. The authors emphasize that complete evaluation of the trachea by bronehoscopie examination before repair of a pulmonary artery sling will prevent postoperative complications and persistence of airway obstruction.--Marleta Reynolds Infant Orthotopic Cardiac Transplantation. C. Mavroudis, H. Harrison, J.B. Klein, et aL J Thorac Cardiovasc Surg 96:912-924, (December), 1988. Sixteen infants in 13 months were evaluated for possible orthotopic cardiac transplantation. Five infants eventually came to transplantation and four survived. Major complications occurred in three of the four survivors. In three patients, a temporary silicone rubber skin patch was used when sternal closure could not be tolerated. Clinical criteria and monocyte and lymphocyte replicative cell kinetics rather than myocardial biopsy were used to diagnose rejection. All four survivors are home 23, 17, 12, and 8 months following surgery. Hospital readmission rate for infection or rejection was 0.91 admissions per patient per year. The rejection rate was 0.5 episodes per patient per year. Cyclosporine, azathioprine, and prednisone were used for immunosuppression. Although these early results are encouraging, long-term survival, quality of life, and the development of subsequent malignancy will influence the future of infant transplantation.--Marleta Reynolds
INTERNATIONAL ABSTRACTS
Neurogenic Pulmonary Oedema Precipitated by Induction of Anaesthesia. N. Braude and T. Ludgrove. Br J Anaesth 62:101-103,
Eosinophilic Granulomatous Lymphadenopathy: Association With Hyper IgE and Eosinophilia. C. Kaplinksy, C. Mor, l.J. Cohen, et al.
(January), 1989.
Pediatr Pathol, 8:377-384, 1988.
A 12-year-old boy with spina bifida and hydrocephalus was admitted with a disconnected ventricular shunt but no evidence of raised intracranial pressure, although he was complaining of headaches and nausea. Shortly after induction the child developed pulmonary oedema. It is postulated that the pressor response of intubation, intermittent positive pressure ventilation through a Magill circuit, and the early induction of halothane produced a critical increase in intra-cranial pressure which, together with the presence of an Arnold-Chiari malformation, precipitated a fulminant form of neurogenic pulmonary oedema (NPO). The author suggests that prevention of NPO in this patient may have been possible by attenuating the intubation-related increase in intracranial pressure by pre-treatment with intravenous lignocaine, the use of a nondepolarizing neuromuscular blocking drug, and ventilation with more efficient circuit.--Ray J. Fitzgerald
Two cases of cervical lymphadenopathy in children associated with hyper-IgE and eosinophilia are described which revealed the features of necrotizing eosinophilic granulomatosis. Immunohistochemical analysis and serologic work-up failed to identify an underlying cause. Central necrosis was an identifying factor. This lesion is differentiated from the fatal form of necrotizing eosinophilic granulomatosis by its association with eosinophilia and hyperIgE.--Eugene S. Wiener
HEAD A N D NECK Cricoid Split for Subglottic Stenosis in Infancy. B.A. Michna, T.M.
Krummel, T. Tracy, Jr, et al. Ann Thorac Surg 45:541-543, (May) 1988. Four infants with subglottic stenosis (three acquired and one congenital) were treated with the anterior cricoid split procedure. The technique and postoperative care are described. Tracheostomy was prevented, and all infants were extubated within 22 days of the procedure. One infant developed an epithelial cyst of the trachea that required surgical management 6 months after cricoid split. Follow-up at from 18 to 24 months demonstrated airway patency and the absence of stridor. The anterior cricoid split can be successfully used to treat subglottic stenosis in a selected group of patients. Marleta Reynolds External Fistula of the Main Parotid Duct; The Alternative Procedure. W, Perdzynski, Z.H. Kalicinski, and T. Bokwa. Z Kinderchir
43:417-418, (December), 1988. The authors present a boy with external fistula of the parotid duct. Treatment consisted of ellipsoid skin incision surrounding the external orifice. After creation of a canal through the cheek, the orifice of the duct was pulled into the oral cavity and sutured to the mucosa. The result was satisfactory without signs of dilatation or cyst formation.--Thomas A. Angerpointer High Resolution Ultrasonography of the Parotid Gland in Children.
Part II. R.W. Seibert and J.J. Seibert. Pediatr Radiol 19:13-18, (November), 1988.
The authors have previously reported a technique for visualizing the parotid gland with high resolution ultrasonography. The fine morphology of the parotid gland as well as normal anatomical landmarks were well visualized with ultrasonography. This study has continued for the past 2 years, and an additional 20 patients with suspected parotid pathology are presented. Ultrasound was helpful in (1) making a specific diagnosis in sialectasis, (2) determining whether parotid swelling was secondary to enlargement of adjacent tissues or indeed secondary to an intraparotid mass, (3) demonstrating whether enlargement of adjacent tissues was vascular by using duplex Doppler scanning, and (4) follow-up of enlarged nodes within the parotid and adjacent to the parotid for development of abscess formation.--Prem Purl
HEART A N D GREAT VESSELS Spontaneous Aortic Thrombosis in a Neonate Presenting as
Coaretation. R.M. Hamilton, P.A. Penkoske, P. Byrne, et al. Ann Thorac Surg 45:564-565, (May), 1988.
Aortic thrombosis in a neonate usually involves the abdominal aorta and is secondary to umbilical artery catheterization. Medical management of this complication has been successful. Spontaneous thrombosis of the thoracic aorta successfully treated with thrombectomy has not been previously reported. This case report describes a newborn infant with clinical signs and symptoms of a critical coarctation of the aorta. Echocardiography demonstrated complete narrowing of the aorta just above the level of a persistent duetus arteriosus. Cardiac catheterization demonstrated the thrombus. At surgery, the thrombus was removed and the aorta patched with Gore-tex. The authors cite the advantage of surgical thrombeetomy over medical management in obtaining immediate relief of the obstruction.--Marleta Reynolds Pulmonary Artery Sling With Tracheal Stenosis: One Staged
Repair. M.St.J. Hickey, and A.E. Wood. Ann Thorac Surg 44:416417, (October), 1987.
Tracheal pathology is often associated with pulmonary artery sling. This case report describes the one stage repair of an infant with pulmonary artery sling and four complete tracheal rings using cardiopulmonary bypass. Preoperative bronehoscopy had demonstrated the severe tracheal pathology. The rings were resected and the trachea repaired primarily. An atrial septal defect was repaired simultaneously. The authors emphasize that complete evaluation of the trachea by bronehoscopie examination before repair of a pulmonary artery sling will prevent postoperative complications and persistence of airway obstruction.--Marleta Reynolds Infant Orthotopic Cardiac Transplantation. C. Mavroudis, H. Harrison, J.B. Klein, et aL J Thorac Cardiovasc Surg 96:912-924, (December), 1988. Sixteen infants in 13 months were evaluated for possible orthotopic cardiac transplantation. Five infants eventually came to transplantation and four survived. Major complications occurred in three of the four survivors. In three patients, a temporary silicone rubber skin patch was used when sternal closure could not be tolerated. Clinical criteria and monocyte and lymphocyte replicative cell kinetics rather than myocardial biopsy were used to diagnose rejection. All four survivors are home 23, 17, 12, and 8 months following surgery. Hospital readmission rate for infection or rejection was 0.91 admissions per patient per year. The rejection rate was 0.5 episodes per patient per year. Cyclosporine, azathioprine, and prednisone were used for immunosuppression. Although these early results are encouraging, long-term survival, quality of life, and the development of subsequent malignancy will influence the future of infant transplantation.--Marleta Reynolds