Epidermal growth factor and transforming growth factor-alpha in middle ear effusion.

Epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) promote the differentiation and proliferation of epithelia as well as the proliferation and chemotaxis of fibroblasts. Additionally, EGF promotes wound healing in tissues composed largely of epithelial cells and fibroblasts. We hypothesized that EGF and TGF-alpha regulate the differentiation and proliferation of the epithelial lining and the migration and proliferation of fibroblasts in the subepithelial space of the middle ear mucosa in children with otitis media. As an initial test of this hypothesis, EGF and TGF-alpha concentrations were measured in 82 middle ear effusions of children undergoing tympanostomy tube placement. EGF was present in 45% of these effusions, and TGF-alpha was present in 6%. The mean concentration +/- SEM values for EGF and TGF-alpha were 19+/-7.6 and 3.7+/-7.9 pg/mL, respectively. In addition, neutrophils, macrophages, and lymphocytes in middle ear effusions stained for EGF by immunocytochemistry. We conclude that growth factors are frequently present in middle ear effusions of children with otitis media.

Interleukin-8 concentration predicts the neutrophil count in middle ear effusion.

Interleukin-8 (IL-8), a potent neutrophilic chemoattractant and inflammatory cytokine, is present in middle ear effusions (MEEs) of children with otitis media and is thought to be responsible for the accumulation of neutrophils in MEEs. We hypothesized that IL-8 concentration predicts the total number and proportion of neutrophils in MEEs. IL-8 concentration and total and differential cell counts were measured in MEEs of children undergoing tympanostomy tube placement for otitis media. IL-8 was present in 80 (98%) of 82 effusions. The mean +/- SEM value for IL-8 was 7342 +/- 847 pg/mL. The mean +/- SEM count and percentage of neutrophils were 1.34 x 10(6) +/- 3.44 x 10(5) and 70.6 +/- 3.1%, respectively. IL-8 concentrations correlated positively with the total number (r = +0.30; P = 0.02) and percentage of neutrophils (r = +0.32; P = 0.01) in the effusion. Additionally, purulent effusions had greater IL-8 concentrations (P = 0.003) and greater neutrophil count (P = 0.03) than mucoid or serous effusions. We conclude that IL-8 is consistently present in MEEs of children and IL-8 concentration predicts the total number and proportion of neutrophils. Furthermore, IL-8 concentration and the total number of neutrophils correlate positively with the type of effusion. These results support the hypothesis that IL-8 recruits neutrophils to the middle ear in MEEs.

Management of deep neck infection.

Deep neck abscesses are serious complications of common upper respiratory tract infections in children. Children are especially prone to airway obstruction complicating deep neck abscess. Pediatricians must understand the presentations and treatment of deep neck abscesses to avoid potentially life-threatening complications.

Short-stay outpatient tonsillectomy.

OBJECTIVE: To determine the risk of complications after discharge in outpatient adenotonsillectomy after a short (< 6 hours) period of postoperative observation. DESIGN: Retrospective chart review. SETTING: Outpatient surgery center at a university hospital. PATIENTS: All patients 18 years of age or less who were scheduled for adenotonsillectomy or tonsillectomy from January 1988 through December 1991. Two hundred fifty-five patient records were reviewed. Twenty-two patients were excluded from the study because of various complicating medical conditions that required planned overnight hospitalization leaving a study population of 233 patients. MAIN OUTCOME MEASURES: (1) Rate and type of complications; (2) duration of postoperative observation. RESULTS: Complication rates of bleeding, emesis, dehydration, and readmission were compared with rates deemed acceptable in the literature (< or = 10%). Power analysis demonstrated that the patient number was sufficient to establish a 95% confidence interval for a complication rate of 0% to 10%. The mean duration of postoperative observation was 136 +/- 48 minutes. Complications included bleeding, emesis, dehydration, and nonscheduled admissions. The total complication rate was 9% (95% confidence interval, 5.5% to 12.7%). The rate of primary bleeding was 1.4%, and all primary bleeding occurred within 75 minutes of arrival in the recovery room; no primary bleeding occurred after discharge from day surgery. This complication rate is comparable with rates previously described in the literature for patients who were observed for a 6- to 12-hour period. CONCLUSION: The findings in this study suggest that short periods of observation are safe for outpatient pediatric patients undergoing adenotonsillectomy after discharge criteria are met.

Airway complications of jet ventilation in neonates.

Four cases of airway complications in infants surviving jet ventilation have been observed at the Children's Hospital of New Mexico. Two cases of necrotizing tracheobronchitis in preterm infants are presented: one was treated with bronchoscopy and removal of the necrotizing tissue; the second was placed on extracorporeal membrane oxygenation, prior to dilation of the affected area. A third child developed subglottic stenosis after intubation with an oversized jet endotracheal tube. A fourth child, with a history of prematurity and jet ventilation as a neonate, was found at 3 years of age to have tracheal webs in the lower third of his airway. Management and follow-up of these four cases, as well as a literature review of the known airway complications of jet ventilation, are presented.

Congenital mid-line cervical cleft.

The mid-line cervical cleft is part of a broad spectrum of congenital mid-line branchiogenic syndromes. Two recent cases of this rare anomaly are presented, along with the clinical presentation, gross pathology and histopathology. The preferred operative technique of complete excision of the cervical cleft with Z-plasty is demonstrated. Embryologic origins and spectrum of severity of the mid-line branchiogenic syndromes is discussed.

Hairy polyp of the eustachian tube.

The hairy polyp of the nasopharynx is a rare but potential cause of airway obstruction in the newborn. A case of hairy polyp arising off the Eustachian tube is reported. Only eight prior cases of Eustachian tube origin have been described in the literature. The terminology and embryology of these tumors are included in the discussion. The site of the tumor and histopathology of this case supports the embryologic origin of a congenital inclusion cyst.

Evaluation of neonatal subglottic stenosis: a 3-year prospective study.

Subglottic stenosis is the most common cause of chronic airway obstruction. It results in prolonged tracheal cannulation of infants and children. Following the widespread adoption over the past 20 years of prolonged intubation for respiratory support in neonates, the incidence of acquired subglottic stenosis increased dramatically. On January 1, 1987, we began a 3-year prospective study to delineate potential etiologic factors involved in the development of subglottic stenosis in neonates. The present study analyzes data from 289 infants. Relationships between birth weight, gestational age, endotracheal tube size, duration of intubation and ventilation, number and difficulty of intubations, and the subsequent need for medical and surgical therapy are discussed. Whole organ larynges from autopsy specimens provide histological correlation.