ABSTRACT
OBJECTIVE: Study the complication rate of tracheostomy in premature infants and identify contributing factors. Setting Two university-based tertiary care children's hospitals. METHODS: The charts of 55 neonates who underwent tracheostomy between January 1997 and December 2002 were reviewed. Group 1 included 32 infants born weighing < 1000 grams. Group 2 included 23 infants born weighing > or = 1000 grams. RESULTS: Group 1 infants had a higher incidence of comorbidities related to prematurity. Thirty-eight infants underwent tracheostomy due to ventilatory dependence, 13 for airway obstruction, and 4 for neurologic debilitation. Sixteen infants (29%) had a complication related to tracheostomy. There was no tracheostomy-related mortality. CONCLUSIONS: Tracheostomy in the preterm infant has the potential for significant morbidity. Meticulous technique, surgeon experience and specialized care may play a role in reducing the complication rate. Complications are usually minor and do not require additional surgical intervention. EBM RATING: C.
Subject(s)
Infant, Premature, Diseases/surgery , Postoperative Complications , Respiratory Insufficiency/surgery , Tracheostomy , Comorbidity , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/epidemiology , Intensive Care, Neonatal , Respiratory Insufficiency/epidemiology , Retrospective Studies , Risk Factors , Tracheostomy/adverse effects , Treatment OutcomeABSTRACT
Despite historical concerns about the spread of infection from the sinuses to the nasal tissues,concurrent septorhinoplasty and endoscopic sinus surgery may be performed safely in most patients who meet the criteria for sinus surgery. However, otolaryngologists should use good medical judgment in selecting patients appropriate for the combined procedures.Patients with extensive sinus pathology or systemic illness are not the ideal candidates for concurrent surgery. It is recommended to perform the septal and sinus surgery first, so that the surgeon may postpone the elective rhinoplasty procedure if unfavorable intraoperative circumstances develop. Overall, when performed in carefully selected patients, contemporaneous rhinoplasty and endoscopic sinus surgery is safe and effective and offers many advantages for the patient.
Subject(s)
Endoscopy/methods , Paranasal Sinus Diseases/surgery , Rhinoplasty/methods , Adult , Aged , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Otorhinolaryngologic Surgical Procedures/methods , Paranasal Sinus Diseases/diagnosis , Risk Assessment , Treatment OutcomeABSTRACT
OBJECTIVE: To study the indications for and outcomes of tracheostomy in a population of preterm infants. DESIGN: Retrospective analysis of case records. SETTING: Two university-affiliated tertiary care children's hospitals. Patients We identified premature infants who required tracheostomies from January 1, 1997, through January 31, 2001. Information on weight, gestational age, comorbid conditions, indication for tracheostomy, and outcomes was collected. Infants were divided by birth weight into group 1 (<1000 g; n = 19 [very low birth weight]) and group 2 (> or =1000 g; n = 14). Comorbid conditions were scored and a total score was calculated for each patient. RESULTS: Group 1 had a higher incidence of patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity. The incidence of congenital or genetic defects was equal in groups 1 and 2 (11 infants [58%] and 8 infants [57%], respectively). Group 1 had a higher average number of failed extubations (5.17 vs 3.18) and a higher oxygen requirement (48.7% vs 30.3%) compared with group 2. Weight at tracheostomy was essentially equal in groups 1 and 2 (3.6 vs 3.7 kg). Subglottic stenosis and laryngotracheomalacia were equally common findings in groups 1 and 2. The average comorbidity score for group 1 was higher than that for group 2 (6.7 vs 2.8). The most common indication for tracheostomy was ventilatory dependence (n = 24 [73%]), compared with airway obstruction (n = 6 [18%]) and pulmonary toilet (n = 3 [9%]). Overall, 6 patients (18%) had a complication related to the tracheostomy. CONCLUSIONS: Severity of pulmonary disease was the most significant factor associated with the need for tracheostomy in preterm infants. A tracheostomy can safely be performed in these infants with minimal morbidity.
Subject(s)
Infant, Premature, Diseases/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Tracheostomy/trends , Birth Weight , Bronchopulmonary Dysplasia/complications , Cerebral Hemorrhage/complications , Comorbidity , Ductus Arteriosus, Patent/complications , Gestational Age , Glottis , Hospitals, Pediatric , Humans , Incidence , Infant, Low Birth Weight , Infant, Newborn , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Laryngostenosis/complications , New Mexico/epidemiology , Patient Selection , Respiratory Insufficiency/epidemiology , Retinopathy of Prematurity/complications , Retrospective Studies , Severity of Illness Index , Survival Analysis , Texas/epidemiology , Tracheostomy/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: We describe, for the first time, the occurrence of two pure examples of spindle cell neoplasm with fibrous and smooth muscle differentiation in the larynx. MATERIALS AND METHOD: Tissue sections from both tumors stained with hematoxylin and eosin were reviewed. Immunophenotypic analysis using keratin, S-100 protein, SMA, and h-Caldesmon markers was performed. RESULTS: Tumors were seen as raised submucosal nodules in the glottic region of two elderly male patients. Histopathologically, the lesions were unencapsulated and composed of spindle cells that manifested variable cellular anaplasia and expressed SMA and were negative for keratin, S-100, and h-Caldesmon. CONCLUSIONS: We document histologically low-grade malignant myofibroblastic tumors of the larynx. Complete excision is advised.
