Neonatal tracheal rupture complicating endotracheal intubation: a case report and indications for conservative management.

Neonatal tracheal injury represents a rare complication of endotracheal intubation. Previous case reports have demonstrated high morbidity and mortality (75%) associated with the rapid occurrence of subcutaneous emphysema, respiratory failure and death in this patient population. This mandates the prompt recognition, evaluation and management of this injury in the neonate. Although there is no clear consensus, previous authors have described both surgical therapy and expectant management. We report a case of a newborn who sustained tracheal rupture following traumatic intubation who survived with expectant management. The pathophysiology, management and indications for conservative management of neonatal tracheal rupture are reviewed.

Vaccine-preventable pediatric postmeningitic sensorineural hearing loss in southern India.

OBJECTIVE: The study goal was to assess vaccine-preventable pediatric postmeningitic sensorineural hearing loss in southern India. STUDY DESIGN AND SETTING: We conducted a prospective pilot study from January through March 2001 in a tertiary pediatric hospital in southern India. RESULTS: Sixty-five patients were studied. Thirty-five (54%) patients had positive cerebrospinal fluid cultures, with the most common organisms being Streptococcus pneumoniae and Haemophilus influenzae. An additional 10 (15%) patients were diagnosed with tuberculous meningitis. Of 28 patients who could comply with audiometric evaluations, 8 (28%) had sensorineural hearing loss. CONCLUSIONS: The etiologic organisms of bacterial meningitis in this study population are similar to those organisms in the developed world, with the minority exception of tuberculous meningitis. Further, a similar prevalence of postmeningitic sensorineural hearing loss occurred. SIGNIFICANCE: An effective vaccination program against S. pneumoniae and H. influenzae type b should reduce the prevalence of sensorineural hearing loss due to bacterial meningitis in developing countries with similar bacterial profiles.

Age-related mechanisms of cricoid cartilage response to injury in the developing rabbit.

OBJECTIVE: To evaluate age-related mechanisms of cricoid cartilage response to injury in an animal model. STUDY DESIGN: A pilot study using monoclonal antibodies to chondrocyte proliferation markers collagen II, aggrecan, and proliferating cell nuclear antigen (PCNA) to evaluate age-related response of injured cricoid cartilage. METHODS: Twenty-seven New Zealand white rabbits aged 4 weeks, 8 weeks, and 1.5 years were studied. Six animals in each age group underwent intracartilaginous injury through cricofissure and tracheofissure. Three animals of each group were used as control subjects. The animals were killed 4 weeks after injury, their cricoid cartilages harvested, and 7-microm sections of tissue obtained. The cricoid tissue sections were stained with immunofluorescent monoclonal antibody markers to collagen II, aggrecan, and PCNA. RESULTS: In all age groups, no control animals had symptoms of airway compromise or immunohistochemical abnormality. For all three markers of chondrocyte proliferation, the 4-week-old animals showed markedly increased staining at the injured edges of cartilage. The 8-week-old animals showed mild increased extracellular staining, and the 1.5-year-old animals showed no increased staining compared with uninjured areas of the cricoid ring and with control animals. CONCLUSION: There was a progressive, age-related attenuation of staining for markers of chondrocyte proliferation in the 8-week and 1.5-year-old rabbits compared with the 4-week-old rabbit cricoids.

Pediatric non-orbital pseudotumor of the head and neck.

OBJECTIVE: To evaluate the incidence, sites of presentation, and treatment outcome of non-orbital pseudotumor of the head and neck in the pediatric population. METHODS: 10-year retrospective case series at a tertiary care center. All patients 18 years of age and younger with non-orbital pseudotumor of the head and neck evaluated and treated at our institution over the study period (1990-2000) were identified through the Systematic Nomenclature of Medicine (SNOMED) database with the keyword 'pseudotumor'. RESULTS: Among 146 patients identified with head and neck pseudotumor at our institution, 15 (10%) were pediatric patients, only three (20%) of whom had pseudotumor in non-orbital sites (the infratemporal and pterygopalatine fossae, submandibular gland, and masseter space). Four (27%) of the 15 had pseudotumor limited to the lacrimal gland, with the remaining eight (53%) being orbital pseudotumor cases. CONCLUSIONS: Similar to cases of orbital pseudotumor, long term systemic steroid therapy proved effective in the management of non-orbital pseudotumor in all three children with eventual disease resolution.