Timing Of Surgical Management Research Articles

Longevity of micronized alloderm in pediatric augmentation laryngoplasty

Objectives: To report the outcomes of augmentation laryngoplasty using micronized alloderm for the management unilateral vocal fold paralysis in children. Indications for acute management and the observed longevity of micronized alloderm is discussed. Methods: Retrospective chart review of patients with unilateral vocal fold paralysis surgically managed at a tertiay care hospital between July 2002 and December 2003. Results: Eight children with unilateral vocal fold paralysis were identified. Age range at the time of surgical management was 3 weeks to 17 years. Follow-up ranged from 6 months to 14 months. Etiologies included cardiac surgery, idiopathic, and brainstem ependymoma. Five of 8 (62.5%) patients were managed in the acute setting; 4 of 8 (50%) of the augmentation laryngoplasty procedures were performed for significant aspiration, and the other 4 patients were managed for dysphonia. The clinically observed longevity of the micronized alloderm was 3 to 6 months. All patients managed for aspiration had significant objective improvement, and 3/4 (75%) were discharged home feeding orally. Three of 5 (60%) of the children managed in the acute setting had recovery of vocal fold function. No airway complications were observed. Conclusions: Augmentation laryngoplasty using micronized alloderm is a safe option for the acute management of aspiration associated with a unilateral vocal fold paralysis in children. The clinically observed longevity of the collagen in children is 3 to 6 months.

Spontaneous ectopic pregnancy and ectopic pregnancy associated with fertility treatment: clinical findings

Objective: The purpose of the study was to investigate the clinical manifestations of patients with spontaneous ectopic pregnancy and patients with the same diagnosis secondary to fertility treatments. Methods: The study included a total of 40 cases. Patients were divided into two groups according to the manner of presentation of ectopic pregnancy. In Group 1, ectopic pregnancy was spontaneous; in Group 2, it was associated with fertility treatments (ovulation induction and IVF). Results: Mean age of all patients was 32.6 ± 5.5 years. In patients with previous ovulation induction, symptoms of concomitant ovarian hyperstimulation syndrome (OHSS) masked clinical manifestations of ectopic pregnancy. There were no significant differences in time of surgical management. Conclusion: The clinical results indicate that patients who develop ectopic pregnancy after fertility treatments have difficult-to-perform diagnoses. High awareness is mandatory in clinicians with this kind of patient.

Deep neck infections in diabetic patients

Deep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management. A retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus. Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P< .05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P> .05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients. In deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.

Otolaryngologic clinical patterns in pediatric infectious mononucleosis

Purpose: Classic infectious mononucleosis (IM) is uncommon in children; therefore, the incidence of severe pharyngotonsillitis complicating the infection is not well established. This study was undertaken to better define the management of complications with special emphasis on the use of parenteral steroids and the role and timing of surgical management. Materials and Methods: A retrospective review of all cases of IM encountered between January 1989 through December 1993 was undertaken. Results: There were 109 patients admitted with IM. Sixty patients (55%) were admitted for severe pharyngotonsillitis. Twenty-nine patients in this subgroup were felt to have symptoms of severe upper airway obstruction and were treated with parenteral steroids. Surgical intervention was required in three patients. Conclusion: The study shows a higher incidence of admissions for severe pharyngotonsillitis complicating IM than reported in the adult literature. It suggests that routine use of parenteral steroids is indicated in cases of severe upper airway obstruction and may decrease the need for suraical intervention.

Surgical risk factors for severe postoperative proliferative vitreoretinopathy (PVR) in retinal detachment with grade B PVR.

Previous studies have shown that grade B proliferate vitreoretinopathy (PVR) is a considerable risk factor for the development of severe postoperative PVR. We conducted a prospective study to elucidate which surgical procedures used in retinal detachment management may stimulate the PVR process in such eyes. The study included 156 eyes of 152 consecutive patients with rhegmatogenous retinal detachment complicated by grade B PVR referred before any failed surgery and operated on between 1983 and 1993. The parameters evaluated by multivariate statistical analysis included the cumulative circumferential extent of the retinal tears, the extent of the scleral buckle, gas injection, vitrectomy, the method used for retinopexy, and the time of surgical management during the period of the study. The incidence of severe postoperative PVR was 25.8% in eyes managed with cryotreatment versus 2.2% in eyes managed with argon laser photocoagulation (P = 0.001). The rate of severe postoperative PVR was not influenced by the other surgical variables. We conclude that cryotherapy may be a risk factor for the development of severe postoperative PVR in retinal detachments associated with grade B PVR.