ABSTRACTUnintentional ingestion of a fish bone is common in children, especially among families with high consumption of seafood. Complications in children are extremely rare. We describe a ...3-year-old healthy boy who had a large bone of Barramundi fish lodged in his upper esophagus causing significant distress. Soft tissue neck radiograph revealed a mildly thickened epiglottis and bulbous and hypertrophied adenoid soft tissue. A 21-mm foreign body was noticed. A flexible fiberoptic laryngoscopy revealed a large fish bone emerging from the left piriform fossa and arcing over the left arytenoid to hover over the posterior glottis. The bone was removed during anesthesia induction before a rigid esophagoscopy. The fish-bone entry point was seen stabbing through the edge of the piriform fossa and running down alongside the esophagus, without causing a through and through perforation. Fish bone ingestion can cause significant complications including perforation of the esophagus. Early suspicion of ingestion, radiological investigation, and swift management are important to ensure reduced complication rate in children.
Melanoma is rare in pediatric patients and even more so in those with darker Fitzpatrick skin types. Although risk factors for conventional melanoma are similar in both adult and pediatric cases, the ...presentation of melanoma in pediatric patients is often distinct from adults. Here, we describe a case of amelanotic ulcerated nodular melanoma with regional lymph node metastases treated with nivolumab in a patient with Fitzpatrick skin type VI.
Because tonsillar enlargement can have substantial ill health effects in children, reliable monitoring and documentation of tonsil size is necessary in clinical settings. Tonsil grading scales ...potentially allow clinicians to precisely record and communicate changes in tonsil size, but their reliability in a clinical setting has not been studied.
To assess the interobserver and intraobserver reliability of the Brodsky and Friedman tonsil size grading scales and a novel 3-grade scale.
Cross-sectional study between June 2012 and August 2013 at a tertiary pediatric otolaryngology outpatient clinic at British Columbia Children's Hospital. We recruited 116 children, aged 3 to 14 years, with no major craniofacial abnormalities. For each child, 2 separate tonsil assessments (with at least a 5-minute interval in between) were conducted by 4 independent observers: 2 staff pediatric otolaryngologists, 1 otolaryngology trainee (fellow or resident), and 1 medical student. Each observer assessed and graded tonsil sizes using 3 different scales.
Interobserver and intraobserver reliabilities were assessed by deriving the intraclass correlation coefficients (ICCs) and Pearson correlation coefficients, respectively. To discount for any asymmetric scores, all data analysis was conducted on the left tonsil measurement only.
Mean interobserver reliability was highest for the Brodsky grading scale (ICC, 0.721; Cronbach α, 0.911), followed by the Friedman grading scale (ICC, 0.647; Cronbach α, 0.879) and the 3-grade scale (ICC, 0.599; Cronbach α, 0.857). The mean intraobserver reliabilities for the Brodsky, Friedman, and modified 3-grade scales were 0.954, 0.932, and 0.927, respectively.
The Brodsky grading scale offered the highest interobserver and intraobserver reliability when compared with the Friedman and novel 3-grade scales. The results of this study would support the uniform use of the Brodsky scale for future clinical and research work.
OBJECTIVE:To estimate the effects of an inpatient initiative to decrease opioid use among women admitted to labor and delivery.
METHODS:We created a multimodal pain power plan with standard ...therapeutic postpartum activity goals rather than pain goals, tiered order sets with scheduled administration of nonsteroidal antiinflammatory drugs (NSAIDs), and embedded changes into the electronic health record. Before the multimodal pain power plan launch, pain was assessed on a 10-point scale; women received NSAIDs for pain levels of 3 or less and opioids for pain levels higher than 3. For this analysis, we included women who delivered at 5 hospitals in the 10 months before and 12 months after the multimodal pain power plan launch. Women with prior substance use disorder or complicated deliveries were excluded and we stratified analyses into women who delivered vaginally compared with by cesarean. Opioid use was converted to morphine milligram equivalent (MME). Women rated pain control in 24-hour blocks using individually ascertained cutoffs. A multivariable regression analysis was performed, and adjusted odds ratios are reported.
RESULTS:We compared the 6,892 women who delivered 10 months before the pain power plan launch to the 7,527 who delivered in the 12 months after the launch. The mean cohort age was 29.6±6.0 years; the majority (75%) were white. Risk of opioid use decreased by 26% among women who delivered vaginally (risk ratio RR 0.74; 95% CI 0.68, 0.81) and 18% among women who delivered by cesarean (RR 0.82; 95% CI 0.72, 0.92). Among women who received opioids, mean MME use decreased 21% (RR 0.79; 95% CI 0.70, 0.88) and 54% (RR 0.46; 95% CI 0.35, 0.61) in the vaginal and cesarean delivery groups, respectively. Fewer women reported acceptable pain levels, with decreases of 82–69% (P<.01) and 82–74% (P<.01) in the vaginal and cesarean delivery groups, respectively. Within the postlaunch cesarean delivery group, women also reported that they were less likely to have their pain well controlled on the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaires (82% vs 62%, P <.01).
CONCLUSION:A standardized multimodal pain power plan reduced opioid use among a large cohort of women admitted to labor and delivery in Central Texas. Despite meeting functional goals, some women reported increased pain during their hospital stay.
Casting a look at pediatric plastic bronchitis Jasinovic, Tin; Kozak, Frederick K; Moxham, J. Paul ...
International journal of pediatric otorhinolaryngology,
10/2015, Letnik:
79, Številka:
10
Journal Article
Recenzirano
Abstract Objectives To review clinical presentations and management strategies for children with plastic bronchitis. Methods Retrospective chart review. Results Seven patients required rigid ...bronchoscopy to remove bronchial casts over a 17-year study period. Mean age at presentation was 60 months. Mean follow-up was 53 months. Co-morbidities included: congenital heart disease ( n = 3), chronic pulmonary disorders ( n = 2) and sickle cell disease ( n = 1). 4 patients required multiple bronchoscopies for recurrent casts. Adjunctive topical therapies were administered in all 7 patients, without complication. Rigid bronchoscopy for cast removal was performed in 2 patients who were on extra-corporal membrane oxygenation (ECMO), using special precautions to safeguard the ECMO catheters. Conclusions Bronchial casts in children may present acutely or sub-acutely. Recurrent casts are unusual; however, in combination with severe cardiac disease may lead to mortality. Adjunctive topical therapies are still under investigation. Special safeguards for ECMO catheters are imperative. This case series complements and adds to the International Plastic Bronchitis Registry.
To present the first published case of Cat Scratch Disease presenting as acute mastoiditis and review the relevant literature to discuss the Otolaryngologic manifestations of this disease and its ...treatment.
A case report and literature review of the Otolaryngologic manifestations of Cat Scratch Disease.
A case report of a clinical scenario followed by a standard literature review. PubMed, EMBASE, and Cochrane database were used to find articles related to the Otolaryngologic manifestations of Cat Scratch Disease.
A 6 year-old female presented to the Otolaryngologist with the typical appearance of acute mastoiditis. CT Scan confirmed breakdown of the osseous septae of the mastoid and mastoidectomy was undertaken. Granulation tissue and infected lymph nodes adjacent to the mastoid cortex were positive for Cat Scratch Disease. The patient was treated expectantly and recovered uneventfully.
This is the first literature report of Cat Scratch Disease presenting as an acute mastoiditis.
Introduction: Oncostatin‐M (OSM) is a member of the interleukin‐6 family of cytokines with controversial roles in bone homeostasis. Evidence supports a role in bone regulation, but the balance ...between healing promotion and acceleration of bone destruction is unclear. It is also uncertain as to whether these varied responses may be dose dependent or related to interactions with other growth factors within the bone microenvironment.
Objective: To determine whether OSM enhances osteoinduction in a rabbit critical calvarial defect model and whether there is a dose response curve.
Hypothesis: OSM enhances osteoinduction, and there is a dose response curve favoring lower doses over higher doses.
Study Design: Controlled animal study using arms of increasing concentrations of OSM in an inactive demineralized bone matrix (DBM) carrier to assess the degree of osteoinduction through standard histomorphometric analysis and a variant of the radiodensitometry technique.
Methods: Twenty‐five skeletally mature New Zealand white rabbits were randomized into control and experimental arms. Incremental doses of OSM (30 μg, 100 μg, and 300 μg/g) in an inactivated guanidine‐extracted DBM (Gu‐DBM) carrier were implanted into a critically sized (13 mm) calvarial defect. Arms of carrier alone and no carrier served as controls. The animals were sacrificed at 4 weeks, and histomorphometry and radiodensitometry analyses were then performed.
Results: All OSM arms showed a statistically significant increase in bone formation and bone density compared with either control arm. There was also a statistically significant increase in bone area by histomorphometry between each OSM group, showing an inverse relationship to dose. Radiodensitometry analysis confirmed a significant bone density difference when comparing experimental groups with controls and also showed a significant difference between the low dose and the higher doses of OSM. It failed to show any significance between the higher two doses when compared with each other.
Conclusions: OSM enhances osteoinduction in vivo and will close a critically sized calvarial defect in a rabbit model when delivered in a Gu‐DBM carrier. There appears to be an inverse dose relationship with new bone formation.
Review of Floor of Mouth Dysontogenic Cysts Macneil, S. Danielle; Moxham, J. Paul
Annals of otology, rhinology & laryngology,
03/2010, Letnik:
119, Številka:
3
Journal Article
Recenzirano
Objectives
We report the common surgical approaches, incidence of sinus tracts, and recurrence rates of floor of mouth dysontogenic (epidermoid, dermoid, and teratoid) cysts in the pediatric ...population.
Methods
Data were derived from PubMed, Medline, Embase, Google Scholar, and manual searches. Three cases from the senior author's (J.P.M.) practice were included. All English-language studies consisting of floor of mouth dysontogenic cysts were included. Case reports of tongue dysontogenic cysts, mandibular dysontogenic cysts, maxillary dysontogenic cysts, and dysontogenic cysts in the neck below the hyoid bone were excluded.
Results
There are 198 case reports, including those presented here, of floor of mouth dysontogenic cysts. They are more common in male patients (55.1%), and the most common location is in the sublingual space (104 or 52.5%). Most floor of mouth dysontogenic cysts can be excised by an intraoral approach. There are 5 reported cases in the literature of recurrent dysontogenic cysts and 11 cases of multiple floor of mouth dysontogenic cysts.
Conclusions
Floor of mouth dysontogenic cysts most commonly present in the sublingual space, and most can be excised by an intraoral approach. Multiple dysontogenic cysts often require a combination of intraoral and extraoral approaches. Recurrence of a dysontogenic cyst may be secondary to a tract not identified at the time of surgery.
Objective:
To determine if there is a dose–response curve for TGF‐β1 in a rabbit calvarial defect model.
Study Design:
Controlled animal study using arms of increasing concentrations of TGF‐β1 to ...evaluate the osteoinductive potential of each arm.
Methods:
Sixteen skeletally mature New Zealand white rabbits were randomized into control and experimental arms. Incremental doses of TGF‐β1 delivered in an inactivated guanidine‐extracted demineralized bone matrix (Gu‐DBM) carrier were implanted into a critically sized calvarial defect. The animals were sacrificed at 4 weeks and histomorphometric analysis was then accomplished.
Results:
TGF‐β1 showed a dose–response relationship, with the higher doses chosen for this study causing more robust osteoinduction.
Conclusions:
In this pilot dosing study, TGF‐β1 demonstrates increasing osteoinduction with increasing dose levels in this animal model. Laryngoscope, 119:126–130, 2009
PDF
