Meningocoele of fallopian canal causing recurrent meningitis.

OBJECTIVE: We report a rare case of meningocoele of the fallopian canal resulting in recurrent meningitis. METHODS: We present a case report together with a review of the world literature concerning meningocoele of the fallopian canal and meningitis. RESULTS: A child developed profound, bilateral, sensorineural hearing loss as a result of meningitis caused by a meningocoele of the fallopian canal. He was treated with bilateral cochlear implantation, with a subtotal petrosectomy and middle ear and eustachian tube obliteration on the affected side. CONCLUSION: Meningocoele of the fallopian canal has rarely been reported. This lesion can present with recurrent meningitis and, rarely, with facial weakness. All children with recurrent meningitis should be investigated for skull base defects. Treatment aims to prevent further episodes of meningitis; we recommend that this is best achieved by the technique of subtotal petrosectomy, with obliteration of the middle ear and eustachian tube.

Extradural haematoma presenting as a contralateral sixth nerve palsy after cochlear implantation.

Intracranial complications after cochlear implantation are rare. The authors present the case of a 13 month old boy with a contralateral abducens nerve palsy following cochlear implantation that led to the diagnosis of an extradural haematoma on computerised tomography scanning. The abducens palsy resolved after evacuation of the haematoma and the patient made an excellent recovery. The literature is reviewed and the mechanism of injury discussed.

Case report: early bilateral simultaneous cochlear implantation in a five-year-old following head injury complicated by acute bacterial meningitis.

Meningitis is an important cause of profound sensorineural hearing loss, especially in children. In this case, a five-year-old suffered a head injury complicated by bacterial meningitis and developed a profound hearing loss. Magnetic resonance imaging at four weeks following injury showed evidence of developing labyrinthitis ossificans and a decision was made to perform bilateral cochlear implantation at an early stage. This report outlines the progress of this interesting case to date and discusses the rationale for the decision to implant in this way.

Recurrent respiratory papillomatosis.

Recurrent respiratory papillomatosis is a relatively rare disease caused by members of the human papilloma virus family. Lesions may occur anywhere throughout the respiratory tract but show a predilection for squamo-columnar epithelial junctions, frequently leading to hoarseness and upper airway obstruction. Rarely, it can progress to squamous cell carcinoma. The impact of recurrent respiratory papillomatosis on patients, their families, and the health care system is considerable. Unfortunately, despite extensive investigational studies, no cure is available for the disease. This article reviews the aetiology of and therapeutic options for recurrent respiratory papillomatosis.

Successful ribavirin therapy for life-threatening laryngeal papillomatosis post liver transplantation.

A 3-yr-old girl developed severe progressive juvenile laryngeal papillomatosis (JLP) 2 yr after liver transplantation (Tx) for biliary atresia. The papillomata were resistant to withdrawal of immunosuppression, to laser surgery, and to subcutaneous interferon (3 MU/m2, three times weekly), necessitating tracheostomy. Oral ribavirin therapy (25 mg/kg/day) in combination with no immunosuppression effectively prevented the rapid recurrence of JLP over 5 yr. Hence, oral ribavirin is a potentially useful therapy in this life-threatening situation and may also be of benefit in other children with severe JLP.

Antrochoanal polyp presenting with obstructive sleep apnoea and cachexia.

A rare presentation of an antrochoanal polyp is reported. A 14-year-old boy presented with obstructive sleep apnoea and subnormal growth velocity for height and weight over a 1-year period. Examination revealed a post-nasal mass which following removal was confirmed histopathologically as an antrochoanal polyp. Relief of the airway obstruction was promptly followed by catch-up growth and subsequent normal growth velocities. The possible mechanisms underlying the cachexia are explored including the possible association with the obstructive sleep apnoea.

De novo laryngeal carcinoma in childhood.

Numerous factors contribute towards a late diagnosis of laryngeal malignancy in childhood. These include its rarity, the similarity of its early symptoms to those of other benign, common childhood conditions as well as the relative difficulty encountered during paediatric laryngeal examination. We believe that these cases are of sufficient interest when they occur to warrant reporting since the consequences of late diagnosis in these young patients can be serious. We present a case of an 11-year-old boy with advanced squamous cell carcinoma of the larynx (T3N0M0), who was successfully treated with primary total laryngectomy and bilateral selective neck dissections to avoid the potential additional morbidity of radical radiotherapy.

Laryngeal mucosal histology in laryngomalacia: the evidence for gastro-oesophageal reflux laryngitis.

OBJECTIVE: To describe the histopathological changes of the mucosa in laryngomalacia; look for any relationship with gastro-oesophageal reflux and to describe the histological changes of reflux laryngitis in laryngomalacia. METHODS: We examined serial histological sections from nine cases of laryngomalacia, who had aryepiglottoplasty and compared the histopathological features with five cases of postintubation inflammatory laryngitis and five age-matched autopsy specimens of normal larynx. RESULTS: Five of the cases of laryngomalacia had mild inflammation in the form of basal cell hyperplasia and chronic inflammation close to the basement membrane. Deeper subepithelium was oedematous. Two cases had moderate and two cases severe inflammation. The latter showed ulceration and a dense band of chronic inflammation in the immediate subepithelium with underlying oedema. Three of the cases had gastro-oesophageal reflux proven by barium swallow. Two of these showed intraepithelial eosinophils. CONCLUSIONS: A band of inflammation of variable intensity just beneath the epithelium with oedema deep to it is the most important histological feature of laryngomalacia. The presence of intraepithelial eosinophils appears to be a histological indication for reflux aetiology of the inflammation.

Marshall-Smith syndrome: the expanding phenotype.

We report a child of 3 years 9 months with the Marshall-Smith syndrome (MSS), characterised by the typical facial features, developmental delay, and advanced bone age. After the diagnosis was made at 5 months of age, careful observation for respiratory complications and failure to thrive was initiated. By 3 1/2 years of age, although our patient had no life threatening respiratory complications, investigation showed significant upper airway obstruction, which has been successfully treated. Aggressive treatment for failure to thrive has also allowed her to maintain a weight on the 50th centile. The purpose of this report is to suggest that early diagnosis and aggressive management may improve the ultimate prognosis with respect to the respiratory and feeding difficulties seen in this rare syndrome.

Two-centre evaluation of the Abbott CD3500 blood counter.

The CD3500 blood counter (Abbott Laboratories) is a 33 parameter fully automated blood counter that produces a five part differential count with flagging of leucocyte abnormalities. In this evaluation excellent correlation between CD3500 and Coulter STKR blood counter was found for all red cell and platelet parameters on the 221 samples tested. Studies of carryover, mixing efficiency and precision also gave excellent results. There was a good correlation with manual 400 cell differential counts for neutrophils, lymphocytes, monocytes and eosinophils for the 468 samples compared. Correlation of CD3500 and manual basophil counts was poor. Normal samples stored at 4 degrees C and analysed while cold showed satisfactory stability for WBC, RBC, Hb, MCV and platelets for 48 h and a stable differential for 24 h. Correlation with the differential count produced by the Coulter STKS showed good correlation for neutrophils, lymphocytes, monocytes and eosinophils; correlation with STKS basophils was poor. False positive flagging rate varied between 8.9% (Band and/or IG) and 0.9% (NRBC) depending on the nature of the flag; 5.8% of samples exhibited two or more false positive flags. No significant breakdowns were encountered during the period of the evaluation. The scatterplot displays of laser light scatter produced by the instrument provide an interesting adjunct to conventional morphology.

Nasal capnography in children: automated analysis provides a measure of obstruction during sleep.

A detailed analysis was made of nasal capnograms obtained from sleeping children with differing degrees of sleep-induced respiratory obstruction, the severe form being known as obstructive sleep apnoea. Clinical observations of these children were compared with analyses of nasal capnography data. During periods when the degree of obstruction was consistent throughout the first hour of sleep, the means and coefficients of variation of several parameters, derived from the capnograms were calculated. The coefficients of variation showed a close relationship to the degree of obstruction. In comparison, measures of end-tidal carbon dioxide concentration proved to be a very insensitive index of the degree of obstruction. The conclusion is that the usefulness of nasal capnography in predicting and grading obstruction can easily be extended by the use of statistical measures of dispersion and that this concept warrants further work.

Penicillamine-induced changes in elastic tissue of the upper respiratory tract.

We describe a patient who developed upper respiratory tract symptoms following long-term treatment of Wilson's disease with penicillamine. These symptoms were attributed to areas of pharyngeal thickening and were treated with a laser. Histological examination of the lesions showed proliferations of abnormal elastic fibres similar to those previously described at other sites, especially the skin, in patients receiving penicillamine. This drug impairs the maturation and reduces the stability of elastic fibres and although elastic tissue throughout the body is affected, we are aware of no previous reports of penicillamine-induced changes presenting with upper respiratory tract symptoms.

A case of congenital angiofibroma.

A case of angiofibroma affecting the right maxilla of a new born baby is presented with histological evidence. We believe this to be the first congenital case of this condition to have been reported.

Hypoxia in sleeping children: overnight studies can be reduced to 4 hours without loss of clinical significance.

Twelve recordings of overnight pulse oximetry representing a range of severity of obstructive sleep disturbance were evaluated by 7 experienced clinicians. Each recording was then scored by counting the number of minutes in each hour affected at any time by a fall in saturation to below 90%. Comparison of the clinical evaluation and the overall scores gave a clear level of 5 minutes per hour at and above which all the assessors agreed that the charts had clinically important desaturation. Overnight pulse oximetry was then performed on 25 children aged between 12 months and 10 years about to undergo adenotonsillectomy. The charts were scored by the method above with a score of 5 or more indicating a positive result for hypoxic episodes. The scores for shortened analysis periods of 1, 2, 3 and 4 hours duration were compared with the overall score and no cases which were negative, up to and including 4 hours, became positive in the overall result. Thus recording pulse oximetry for 4 hours provides sufficiently accurate information for clinical purposes.

Recurrent nerve palsy due to parathyroid cyst.

Cysts of the parathyroid gland are uncommon neck masses and difficult to diagnose. They can cause symptoms by endocrinological function or by pressure on surrounding structures. A case of recurrent nerve palsy due to a parathyroid cyst is presented. Aspiration of parathyroid cysts can be diagnostic and therapeutic in some cases.

Management of epistaxis in children.

A randomised clinical trial of antiseptic nasal carrier cream (Naseptin) and silver nitrate cautery in the treatment of epistaxis in children was carried out. Fifty-four percent responded to cautery with silver nitrate and 50% to treatment with Naseptin antiseptic carrier cream. There were 24 patients in each group. No statistically significant difference was observed between the groups when tested with the chi 2 test. We believe that the first line treatment of epistaxis in children should be the use of antiseptic nasal cream.