An Evaluation Protocol of the Upper Airway for Pediatric Patients with Stridor or Extubation Failure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adequate evaluation of the upper airway is critical in the management of pediatric patients with stridor or extubation failure. For this purpose, we designed an evaluation protocol of the upper airway for these patients, in collaboration with Dept. of Pediatrics, Intensive care team and Anesthesiology. Here we present the clinical results of our evaluation protocol and provide information about the etiology and management of the upper airway problems. SUBJECTS AND METHOD: Clinical data of 380 pediatric patients (M:F=231:149) having airway evaluation for their problems (stridor or extubation failure) were retrospectively analyzed. Among them, patients of age less than 3 months ranked first (30.0%). Comorbidities of pulmonary diseases (30.8%) and cardiovascular diseases (29.5%) were found. The pre and post-evaluation diagnosis, management and prognosis were evaluated and the usefulness of an airway evaluation protocol was discussed. RESULTS: Frequent pre-evaluation diagnoses were subglottic stenosis (55.2%), laryngomalacia (12.6%) and tracheal stenosis (9.2%) and these were changed to subglottic stenosis (44.5%), laryngomalacia (9.7%), tracheal stenosis (6.6%) and no abnormality (14.5%). Particularly, 50% of pre-diagnosis laryngomalacia, 25% of subglottic stenosis and 37% of tracheal stenosis were corrected to other causes by airway evaluation. The procedures were exam only (41.6%), endoscopic dilatation (20.8%) and tracheostomy (17.9%). In 190 out of 380 (50.0%), extubation was successful, but 151 patients (39.7%) had tracheostomy tube. CONCLUSION: Adequate evaluation of the upper airway in pediatric patients with stridor or extubation failure can facilitate the diagnosis and management of their problems.

Real-Time Video-Assisted Retrieval of Airway Foreign Body in Very Young Pediatric Patients

OBJECTIVES: Advancements in medical endoscopy and techniques of rigid bronchoscopy for foreign body removal have enabled higher diagnostic accuracy, reduced morbidity and precise manipulation. However, in pediatric patients, endoscope-combined forceps may be too big to fit into the small sized airway. Here we present our method of endoscope assisted rigid bronchoscopy in pediatric patients and compare the clinical benefits with conventional naked-eye rigid bronchoscopy. METHODS: We used a 2.7 mm, 0degrees straight endoscope and small caliber grasping forceps with 3.0 to 4.5 mm sized rigid bronchoscopy for very young (<3 years of age) patients of foreign body aspiration. As an assistant held the rigid bronchoscope in situ, the operator could manipulate the endoscope and forceps bimanually. With endoscopic guidance, the foreign body retrieval was performed carefully. The clinical advantages were compared between our endoscope-assisted method (n=29) and the conventional bronchoscopy method (n=33) in terms of operation time and recovery (hospital stay). RESULTS: Bimanual endoscope-assisted rigid bronchoscopy method was technically feasible and safe. The operation time was less, compared to the conventional technique and the patients recovered more quickly. In all cases, our method completely removed the foreign body without need of a second bronchoscopy procedure. CONCLUSION: Bimanual endoscope-assisted retrieval of airway foreign body in very young age pediatric patients was superior to the conventional naked-eye method concerning accurate manipulation and safety.

Extrusion of Gutta-Percha into the Nasal Cavity Causing Maxillary Fungal Sinusitis: A Case Report

There have been few reports about extrusion of endodontic obturation materials into the maxillary sinus and inducing fungal sinusitis. Endodontic materials and fungus balls both are seen as high attenuation in a CT scan so may be overlooked. We report such a case in which the surgeon and radiologist had missed the foreign materials on preoperative CT scans, and recognized the filling defect on the alveolar bone and a foreign body in the nasal cavity postoperatively.

Extrusion of Gutta-Percha into the Nasal Cavity Causing Maxillary Fungal Sinusitis: A Case Report

There have been few reports about extrusion of endodontic obturation materials into the maxillary sinus and inducing fungal sinusitis. Endodontic materials and fungus balls both are seen as high attenuation in a CT scan so may be overlooked. We report such a case in which the surgeon and radiologist had missed the foreign materials on preoperative CT scans, and recognized the filling defect on the alveolar bone and a foreign body in the nasal cavity postoperatively.

The Role of Endoscopic Ultrasonography in Staging of Esophageal Cancer : Preliminary Report / 대한소화기내시경학회지

The prognosis of esophageal cancer is poor and strategies for treatment depend on the tumor stage at the time of diagnosis. Surgery is the main therapeutic modality in esophageal cancer and known as the only treatment for cure. Preoperatively it is most important to assess whether the primary tumor is completely resectable or not. Previous staging modality such as CT can not clearly define the depth of invasion and lymph node metastasis of esophageal cancer which is the most important factor in assessing the possibility of curative resection. Endoscopic ultrasonography is now considered as an useful method in evaluating staging and resectability of esophageal cancer. We compared the findings of endoscopic ultrasonography with pathology result to evaluate the accuracy of this new technique in staging of esophageal cancer in 4 esophageal cancer patients who received surgery among the 23 patients assessed by endoscopic ultrasonography due to esophageal cancer, The depth of invasion, lymph node metastasis, and staging was correct in 3 among 4 patients. We consider endoscopic ultrasonography is an useful technique in staging of esophageal cancer.