ABSTRACT
The incidence of gastroesophageal reflux in recurrent croup was evaluated by a retrospective analysis of patients at the Children's Hospital of Michigan from 1986 to 1991. Sixty-six patients required hospitalization for recurrent croup during this 6-year period. Of the patients evaluated, 47% with recurrent croup had an additional diagnosis established of gastroesophageal reflux. In patients with three or more hospitalizations for croup, there was a 63% association with gastroesophageal reflux. Compared to all patients with recurrent croup, the patients with gastroesophageal reflux tended to be younger and had a shorter interval between episodes of croup. A prospective series of six cases of recurrent croup was seen in consultation. The diagnostic procedures involving lipid-laden macrophage quantitation, endoscopy, and gastroesophageal reflux scintiscans were utilized to establish the diagnosis of gastroesophageal reflux with tracheal aspiration. The results of these studies and the follow-up is discussed.
Subject(s)
Croup/complications , Gastroesophageal Reflux/epidemiology , Croup/epidemiology , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Hospitalization/statistics & numerical data , Humans , Incidence , Infant , Male , Pneumonia, Aspiration/complications , Pneumonia, Aspiration/diagnosis , Prospective Studies , Recurrence , Retrospective Studies , Time FactorsABSTRACT
In the past, various tracheotomy incisions have been used at the Children's Hospital of Michigan with the occurrence of complications related to accidental decannulation and immediate recannulation. Since that time the inferior based tracheal cartilage flap has been used to minimize early complications. A retrospective study of 126 pediatric tracheotomies performed at the Children's Hospital of Michigan from June 1986 to January 1991 was reviewed. Only tracheotomies performed by a staff otolaryngologist utilizing the inferior based tracheal cartilage flaps were reviewed. This study includes patients with a 6 month to 5 year follow up. The early complication rate was 4%, while the late was 50%. Stomal granulation tissue was comparatively increased in this series of patients but did not hinder decannulation. We consider the use of the inferior based tracheal cartilage flap in the pediatric population a safe and effective technique without increasing the morbidity of long-term tracheotomy.
Subject(s)
Trachea/surgery , Tracheotomy/methods , Airway Obstruction/surgery , Child , Child, Preschool , Female , Fistula/etiology , Follow-Up Studies , Granulation Tissue/pathology , Humans , Infant , Infant, Newborn , Male , Mediastinal Emphysema/etiology , Retrospective Studies , Skin Diseases/etiology , Time Factors , Trachea/pathology , Tracheal Diseases/etiology , Tracheal Stenosis/etiology , Tracheotomy/adverse effects , Treatment Outcome , Ventilators, MechanicalABSTRACT
The treatment of keloids remains difficult. In experimental studies, lathyrogenic agents and colchicine have been shown to be effective in keloid prevention. Recently, a study was published of a new animal model utilizing human keloids implanted in athymic mice. We used the same model to compare the effects of penicillamine, acetylcysteine, colchicine, and triamcinolone acetonide. Unexpectedly, all keloids implanted showed a growth peak at 4 weeks and then regression in size. Histologic sections of the implanted keloids revealed peripheral vascularity, collagen bundles similar to the parent keloids, and no evidence of implant rejection. After 8 weeks, the mice treated with the lathyrogenic agents exhibited a higher rate of regression when compared with the control mice. While triamcinolone acetonide may have prevented keloid implant growth, drug toxic reaction may have been a factor.
