Aetiological profile of paediatric stridor in a Malaysian tertiary hospital

Background: Conditions causing stridor in paediatric patients can range from minor illnesses to life-threatening disorders. Proper evaluation and correct diagnosis are essential for timely intervention. The objective of this study was to determine the aetiological profiles and the management of paediatric patients with stridor referred to the Otorhinolaryngology Department of Hospital Serdang. Methods: Medical records of all paediatric patients presenting with symptom of stridor from January 2010 to February 2015 were reviewed retrospectively. The patients’ demographic data, clinical notes, laryngoscope findings, diagnosis and management were retrieved and analysed. Results: Out of the total 137 patients referred for noisy breathing, 121 patients had stridor and were included in this study. There were 73 males and 48 females—most were of Malay ethnicity (77.7%). The age of presentation ranged from newborn to 10 years, with a mean of 4.9 months. Eighteen patients (14.9%) had associated congenital pathologies. The majority were congenital causes (90.9%), in which laryngomalacia was the commonest (78.5%), followed by subglottic stenosis (5.0%), vallecular cyst (2.5%) and congenital vocal fold paralysis (2.5%). Twelve patients (9.9%) had synchronous airway lesion. The majority of the patients were managed conservatively. Thirty-one patients (25.6%) required surgical intervention, of which only one needed tracheostomy. Conclusion: Laryngomalacia was the commonest cause of stridor among paediatric patients. A synchronous airway lesion should be considered if the child has persistent or severe symptoms. The majority of the patients were managed conservatively.

Tracheal resection and anastomosis: an 11 year management outcome

To evaluate the etiology, perioperative management and outcome of surgery in cases of tracheal stenosis. This was a retrospective analysis of patients with tracheal stenosis who underwent resection with anastomosis from January 2000 until December 2010. Ten patients, aged between 15 to 53 years old [mean of 34.4 years] were included. Post intubation injury was the major cause of tracheal stenosis [n=8], followed by external laryngeal trauma [n=2]. Using the Cotton-Myer classification, 60% of patients had Grade III stenosis whilst 40% had Grade IV stenosis. Intravenous corticosteroids were given 24 hours before extubation. Four patients were well post- operatively without complications. The most common complication in the other patients was granulation tissue in the anastomosis region [n=3], vocal cord paresis [n=2] and one restenosis [n=1]. Four of these patients underwent examination under anesthesia with removal of granulation tissue and/or laser dilatation. However, 2 cases needed Shian Lee operation and required T-tube until present. The success rate for tracheal resection and anastomosis is taken as the number of patients successfully decannulated, which was 80%. Tracheal resection with end-to-end anatomosis was a successful procedure for cervical tracheal stenosis, with low mortality and few complications related to it

Growth kinetic study on normal and microtic chondrocytes of human auricular cartilage

Chondrocytes were isolated from normal and microtic human auricular cartilage after ear surgery carried out at Universiti Kebangsaan Malaysia Medical Centre. Chondrocytes were cultured and expanded until passage 4. After reached confluence, cultured chondrocytes at each passage (P1, P2, P3 and P4) were harvested and assigned for growth profile analysis. There was no significant difference in cell viability between both normal and microtic samples (p = 0.84). Both samples showed no significant differences for growth profile parameters in terms of growth rate, population doubling time and total number of cell doubling, except in passage 1, where there is significant difference in cell growth rate (p = 0.004). This preliminary data has indicated that chondrocytes from microtic cartilage has the potential to be used in the reconstruction of human pinna in the future.