ABSTRACT
16 infants with severe distal tracheal stenosis (TS) seen from 1978-1988 are reviewed. Diagnosis was established by endoscopy and confirmed by radiographic methods, including magnetic resonance imaging (MRI) in three cases. Types of TS ranged from segmental stenosis to complex lesions involving the carina and bronchi. Associated vascular anomalies were found in nine patients (56%). All patients needed long-term intubation or a tracheostomy (seven cases) for stenting of the airway. Patients with congenital TS (CTS) were treated by tracheal resection (two survivors), dilatation (one survivor, two non-survivors), or observation (two non-survivors). Patients with pulmonary artery sling (PAS) were treated by division of the vascular sling (three survivors, one non-survivor), or combined vascular and tracheal surgery (one non-survivor). One patient with dilated pulmonary arteries compressing both main bronchi died in spite of oxygen therapy. Two cases of compression by an anomalous aorta were managed with dilatation (one survivor, one non-survivor). One patient with a severe stricture after a tracheal resection was successfully treated by dilatation. The overall mortality was 50%. We conclude that 1. endoscopic examination of the tracheobronchial tree and thorough evaluation of associated anomalies is mandatory in symptomatic patients; 2. if indicated surgical correction is the treatment of choice for tracheal stenosis; 3. dilatation and stenting of the stenosis are invaluable tools in the management of these infants.
Subject(s)
Tracheal Stenosis/diagnosis , Abnormalities, Multiple/therapy , Airway Obstruction/etiology , Bronchoscopy , Dilatation/methods , Female , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Prognosis , Pulmonary Artery/abnormalities , Surgical Procedures, Operative/methods , Tracheal Stenosis/complications , Tracheal Stenosis/therapyABSTRACT
Processes of atelectasis and pulmonary shrinkage are not confined to the right middle lobe. This fact is illustrated by case reports of five of our nine such patients. All cases shared common clinical and morphologic similarities: congenital malformations of the bronchial skeleton, compression, and chronic inflammation produce comparable pulmonary morphology that always includes atelectasis. Atelectasic processes of longer duration require surgical resection; this led to cures in all the authors' patients.
Subject(s)
Middle Lobe Syndrome/surgery , Bronchiectasis/diagnostic imaging , Bronchiectasis/pathology , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Male , Middle Lobe Syndrome/diagnostic imaging , Middle Lobe Syndrome/pathology , Pulmonary Atelectasis/diagnostic imaging , Pulmonary Atelectasis/surgery , RadiographyABSTRACT
This is a report on five boys aged between 1 and 5 years who, after prolonged submersion in cold water, were treated at our department. On being taken out of the water, all the patients were clinically dead. After 1- to 3-hour successful cardiopulmonary resuscitation, with a rectal temperature of about 27 degrees C, they were rewarmed at a rate of 1 degree/hour. Two patients died within a few hours after the accident. One patient survived with an apallic syndrome, 2 children survived with no sequelae. In the event of a water-related accident associated with hypothermia, we consider suitable resuscitation to have preference over rewarming measures. The most important treatment guidelines and prognostic factors are discussed.
