bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Periorbital Infections: 5‐Year Retrospective Study
Authors: Marques Marta Canas , Santos Alberto , Simao Marco Alveirinho , Andrea Mario , Dias Oscar 
Published: September 2011

ObjectivePeriorbital infections in the pediatric population are a common situation in hospital emergency care that can lead to visual loss, intracranial infection, or even death. We evaluated presentations and outcomes of pediatric periorbital cellulitis in order to understand different etiologies and stratifying risk populations that need different diagnostic and treatment approaches.MethodWe retrospectively reviewed the pediatric patients admitted at our institution with the diagnosis of periorbital cellulitis over a period of 5 years. They were classified in subgroups according to Chandler and cross‐referenced in demographics, clinical features, co‐morbidities, days of in‐hospital staying, CT findings, and treatment modalities.ResultsWe identified 112 children with periorbital cellulitis, 63 pre‐septal and 49 post‐septal. There were statistically significant differences between the two groups in regard to age (P <. 001) and history of trauma or skin infection (P <. 001). Proptosis (P <. 001), diplopia (P <. 01) and ophthalmoplegia (P <. 001) were more frequent in post‐septal infections and surgical intervention was exclusive of this group. Subperiosteal abscess patients were significantly older (P <. 05), and all of them had diagnosis of acute sinusitis (P <. 05). Proptosis (P <. 05), ophtalmoplegia (P <. 05) and diplopia (P <. 05) were also differentiating features of subperiosteal abscess.ConclusionPre‐septal infections are more common in younger children. Older children with subperiosteal abscesses need surgical intervention more often. Proptosis, diplopia, and opfthamoplegia are significant identifying features of post‐septal infections, particularly in surgical patients. Trauma or skin infections are relevant findings of pre‐septal infections. Post‐septal infections are mostly a complication of acute sinusitis.
Predictive Factors of Prolonged Hospital Stay in Tonsillectomy Patients
Authors: Carr Michele M. , Choby Garret , Setabutr Dhave 
Published: September 2011

ObjectiveTonsillectomy remains one of the most common surgeries performed in the pediatric population. Factors that are predictive of a prolonged stay after tonsillectomy are useful in planning postop care.MethodA retrospective chart review was completed inclusive of all pediatric patients who had tonsillectomy at a tertiary medical center from March 10, 2010, to January 1, 2011. Preoperative variables were analyzed to determine predictors of extended hospital stay (defined as > 24 hours).ResultsA total of 210 patients were reviewed. Thirty‐three patients (15.7%) had hospital stays greater than 24 hours. Indications for tonsillectomy included obstructive sleep apnea (69.5%), tonsillitis (9.5%), and asymmetry (1.9%). Twenty‐eight (84.8%) patients had extended stays for poor oral intake. Fever and respiratory complications accounted for 0.06% respectively. Patients with extended stays were younger (P <. 001), weighed less (P <. 001), and had higher apnea‐hypopnea indices (P =. 043). Patients with a history of sickle cell crises or bronchodilator use, along with those who had state funded insurance (P <. 05), were more likely to have extended stays.ConclusionFactors from the history and physical of patients may predict which patients are at higher risk for extended hospital stays after tonsillectomy. Predictors of extended stays include younger and smaller children, those with a prior history of sickle cell crises, those using bronchodilators, and those with state funded health insurance.
Predictors of Bleeding Disorders in Children with Epistaxis: Value of Preoperative Tests and Clinical Screening
Authors: Elden Lisa M. , Reinders Megan , Witmer Char 
Published: September 2011

ObjectiveChildren with recurrent epistaxis despite medical therapy may be at higher risk of having a bleeding disorder. The objective of this study was to identify the prevalence of previously undiagnosed bleeding disorders in children with severe epistaxis who failed medical therapy requiring intraoperative nasal cautery.MethodRetrospective chart review from October 15, 2006 to December 31, 2010. Inclusion criteria: children (<19 years) with epistaxis referred to otolaryngology, no known bleeding disorder, and failed medical therapy requiring nasal cautery. Data collected: duration and severity of epistaxis, bleeding history, family history of bleeding. Screening CBC, PT and PTT were performed on all of patients.ResultsOf 248 subjects referred for epistaxis, 47 met study inclusion criteria (mean age 8.6 ± 3.8 years; male:female ratio 29:18). Coagulation studies revealed 12.8% (6/47) prolonged PT, 8.5% (4 /47) prolonged PTT, 10.6% (5/47) prolonged PT and PTT. Three with borderline levels proceeded to surgery. Twelve were referred to hematology secondary to abnormal coagulation studies. Of these, five patients (5/12, 42%) were diagnosed with a bleeding disorder (3‐type 1 von Willebrand’s disease (VWD), 1‐platelet aggregation disorder, and 1‐factor VII deficiency). Overall, 6.4% (3/47) had VWD in this cohort, which is higher than the reported prevalence of 1%.ConclusionKnowledge of whether a child has a coagulopathy prior to surgery can limit complications. In this highly selected group of patients with persistent epistaxis, 10.6% (5/47) had a bleeding disorder. It is important to consider hemostatic testing in high risk patients.
Remote Monitoring of Home‐based Noninvasive Ventilation in Children with Obstructive Sleep Apnea‐Hypopnea Syndrome and Concomitant Risk Factors
Authors: Sabo Liu 
Published: September 2011

ObjectiveInvestigate whether an internet‐based remote monitoring system could provide an effective, practical, and safe clinical pattern for children with obstructive sleep apnea‐hypopnea syndrome (OSAHS) who require home‐based noninvasive positive pressure ventilation (NIPPV) therapy on a long‐term basis.MethodThree patients were treated in the unit from March 2009, and the results were analyzed. Variables of the ventilator were monitored with a remote monitoring system to observe the status of home‐based treatment. Interventions were administered as appropriate, and a questionnaire survey was conducted to investigate the performance of the remote monitoring system.ResultsAs of April 1, 2010, pulmonary hypertension in 1 patient had been cured, while the other 2 patients remained in treatment. In all three patients, poor compliance and lower efficiency of the use of the ventilator were seen in early stages of treatment. After a period of remote monitoring and education, both parameters were significantly improved. A survey conducted with the patients’ families and their professional medical staffs revealed that the TELETREK remote monitoring system was safe, convenient, and easy to operate and helped save time and cost as compared to traditional regular follow‐up visits to the hospital.ConclusionRemote monitoring systems provide an effective, practical, and safe clinical pattern for patients with OSAHS and associated risk factors who need home‐based noninvasive ventilation therapy on a long‐term basis.
Sickle Cell Disease and Pediatric Adenotonsillectomy
Authors: Goldman Richard Andrew , Reese James , Johnson Charles M. 
Published: September 2011

ObjectiveDetermine the safety of a primarily outpatient management protocol for children with sickle cell disease undergoing adenotonsillectomy.MethodA retrospective chart review was conducted of children with sickle cell disease undergoing adenotonsillectomy over a four year period beginning January 2007 at an academic tertiary care facility. Preoperatively patients underwent transfusion for hemoglobin less than 10g/dL. Postoperatively, they were monitored overnight and discharged the following day when possible.ResultsFifteen pediatric patients with homozygous sickle cell disease and one patient with sickle beta thalassemia disease were identified, all of whom underwent adenotonsillectomy. The majority of patients (11) were discharged on the first postoperative day with the average length of postoperative admission for all patients being 1.5 days (range, 1‐5). Two patients (13 percent) experienced postoperative pain crises. There were no cases of postoperative bleeding, CVA, or acute chest syndrome.ConclusionAdenotonsillectomy in patients with sickle cell disease can be performed safely and effectively with careful outpatient preoperative management and brief postoperative hospitalization.
Steroids in Pediatric Bell Palsy: A Systematic Review
Authors: Pitaro Koby , Waissbluth Sofia , Daniel Sam J. 
Published: September 2011

ObjectiveConduct an updated systematic review on the outcome of Bell Palsy (BP) in children following steroid treatment.MethodMedline, Embase, Cochrane Library, and BIOSIS Previews databases were searched obtaining articles from years 2000 to 2010 without any language restriction. Articles describing children aged 0 to 18 years with BP treated solely with corticosteroids were included. The outcome measure was facial movements based on clinical scales.ResultsA total of 2293 papers were initially identified. Following review by 2 authors, 68 papers were analyzed in a hard‐copy format. Finally, 6 studies were eligible to be included in the systematic review. Four of the studies exclusively included children with BP where in 2; various etiologies of facial palsy were described. The nontreated groups were smaller than the treated groups. Type of steroid and duration of treatment were inconsistently specified. Outcome measures used include the House‐Brackmann scale, Yanagihara grading system, and clinical evaluation. Studies analyzed were retrospective cohorts or case‐series and were categorized as level 4 of evidence.ConclusionThere were no controlled trials, and level 4 publications predominate. Therefore, the role of steroid treatment for BP in children is still inconclusive. Further studies are required.
Surgery for Pediatric Invasive Fungal Sinonasal Disease
Authors: Ardeshirpour Farhad , Belani Kiran , Sencer Susan , Sidman James D. , Lander Timothy 
Published: September 2011

Objective1) Evaluate the management and outcomes of immunocompromised children with invasive fungal sinonasal disease who were treated with radical surgery. 2) Compare outcomes of radical surgery with less aggressive surgical debridements described in the literature.MethodFrom 1994 to 2007, eleven pediatric patients with invasive fungal sinonasal disease, who were treated by the same pediatric otolaryngologist, were retrospectively evaluated. Demographics, oncologic diagnoses, absolute neutrophil counts, symptoms, CT scan findings, biopsy and culture results, surgical procedures, anti‐fungal therapies, outcomes, and survival were among the data collected.ResultsThere were 4 males and 7 females with an average age of 10 years (range, 2‐14 years). Ten of the patients had relapsed leukemias. Six patients had acute lymphoblastic leukemia, 5 had acute myeloid leukemia. The average number of severely neutropenic days prior to diagnosis of invasive fungal infection was 18 days (range, 8‐41 days). Seven patients had alternaria, 4 had aspergillus. Nine patients underwent an external medial maxillectomy, 5 of which were bilateral, and six underwent septectomy. All eleven patients (100%) were cured of their invasive fungal sinonasal disease and did not relapse. Three patients eventually died from other causes.ConclusionInvasive fungal sinonasal disease is a life‐threatening problem in immunocompromised children, especially with relapsed leukemia. Successful treatment depends on timely and aggressive surgical, anti‐fungal, and supportive therapies. This is the largest series of pediatric patients with invasive fungal sinonasal disease who underwent aggressive surgery with the best outcomes to date.
Swallowing Dysfunction and Preoperative Assessment for Gastrostomy and Fundoplication
Authors: Cheung Esther , Shah Jaecel , Roy Soham , Douglas William , Tsai Felix W. 
Published: September 2011

ObjectiveEvaluate the need for gastrostomy and fundoplication in neonates following aortic arch surgery.MethodSixty neonates from 2007 to 2010 who underwent the Norwood procedure, aortic arch augmentation and reconstruction, or coarctation repair were reviewed retrospectively. Results of modified barium swallow (MBS), laryngoscopy, upper GI series (UGI), and 24‐hour pH probe were reviewed for patients who underwent gastrostomy tube placement with or without fundoplication.ResultsAfter aortic arch procedures, 32 neonates (53.3%) underwent gastrostomy tubes (GT); an additional 26 (43.3%) patients also underwent concomitant fundoplication. Of those with unilateral vocal fold immobility, 50% (8 out of 16) aspirated on MBS, 10 out of 18 (55.6%) revealed reflux on UGI, but only 2 out of 9 (22.2%) had abnormal pH studies. Of those with normal vocal fold mobility, 88.9% (8 out of 9) patients demonstrated aspiration on MBS, 9 out of 12 (75%) showed reflux on UGI with one malrotation discovered, and 2 out of 5 (40%) patients had abnormal pH probe studies.ConclusionNeonates who undergo aortic arch procedures are at high risk of aspiration and other swallowing abnormalities. In this study, over half underwent GTs and many also required fundoplication, although results of pH probe studies seem to be inconsistent and limited, and therefore, its clinical usefulness is questionable for this patient population.
The Benefit of Brain MRI in the Evaluation of Pediatric Dysphagia
Authors: Allis Terah J. , Romans Ryan , Goebel Deborah , Thomas Heather , Sewell Ryan 
Published: September 2011

ObjectiveDetermine rates of brain MRI abnormalities for dysphagia in a pediatric aerodigestive center. Examine trends in swallowing improvement based on brain MRI pathology and syndromic status. Recognize the incidence of Chiari malformations and the association with dysphagia. Be able to counsel families regarding likelihood of swallowing improvement based on abnormal MRI.MethodRetrospective review of 222 pediatric medical records (2001‐2010) enrolled in an aerodigestive clinic. Swallow studies and brain MRI reports were reviewed. Patients were subdivided into syndromic and nonsyndromic, n = 62, 159. All patients with MRI for dysphagia were analyzed statistically for brain abnormalities, Chiari malformation, correlating with swallowing improvement and resolution.ResultsOf 222 children with dysphagia 45 had brain MRI for dysphagia. A total of 14 had abnormalities. Eleven, 24%, were nonsyndromic with abnormal MRI. Two out of 11 were diagnosed with Chiari comprising 5% of MRIs performed for dysphagia in nonsyndromic children. One Chiari I patient did not undergo surgery and demonstrated improvement. No Chiari patients had resolution of dysphagia, yet 50% improved P =. 486. MRI did not correlate with symptom resolution. Nonsyndromic with abnormal MRI for dysphagia displayed 60% improvement vs 56% improvement with normal MRI, P = 1.0. Resolution rates were similar for patients with abnormal MRI (18% resolution rate) and normal MRI (22% resolution rate), P = 1.0.ConclusionAt our institution children with persistent dysphagia undergo brain MRI to exclude Chiari malformation. Two malformations were diagnosed (5%), supporting MRI in dysphagia evaluation in diagnosing Chiari. However, it does not support MRI utility in predicting resolution, as there was no difference statistically between the brain MRI groups outcome.
The Effect of Adenotonsillectomy in the Production of IGF‐1 (Insulin‐like Growth Factor‐1) in Children
Authors: Pascoto Gabriela R. , Abreu Cassiana , Santos Fabio P. , Pignatari Shirley S. N. , Stamm Aldo E. C. , Weber Raimar 
Published: September 2011

ObjectiveAirway obstruction caused by adenotonsillar hypertrophy is the main cause of snoring and sleep apnea in children and often associated with several other signs and symptoms, including growth development. The objective of this study was to evaluate the effect of adenotonsillectomy in the production of IGF‐1 (insulin‐like growth factor‐1) in children.MethodA total of 26 children of both sexes with adenotonsillar hypertrophy with formal indication for adenotonsillectomy (study group) and 21 control children (with indication for surgery for other reasons, eg, postectomy) were submitted to evaluation of peripheral blood IGF‐1. The samples were taken immediately preoperatively and 30 days after surgery.ResultsThe preoperative levels of IGF‐1 showed values within the normal range for age in both groups. Two children in the study group had values below normal for their age. The comparison of pre‐ and postoperative levels in children undergoing tonsillectomy showed a statistically significant increase (P <. 01) by Student t test for paired samples. The 2 children with preoperative values below normal for age recovered normal levels of IGF‐1 after surgery.ConclusionThe data from our study suggest that adenotonsillar hypertrophy, resulting in snoring and sleep apnea can affect negatively the production of circulating IGF‐1, probably related to the disturbances of height and growth development, and demonstrate that adenotonsillectomy contributes to enhancing and restoring the values of IGF‐1.
An Audit of Adherence to SIGN Guidelines for Tonsillectomies: Completion of Third Cycle
Authors: Phua Chu Qin , Chan John , Mahalingappa Yogesh , Bhalla Rajiv K. , Rashid Mamun , Karagama Yakubu 
Published: September 2011

ObjectiveIt is important to ensure that our listing practice for tonsillectomy is in keeping with the best evidence available, as stated by the Scottish Intercollegiate Guidelines Network (SIGN). We audited the accuracy of documentation of the SIGN guideline indications for tonsillectomies to ensure appropriate listing of such patients.MethodMedical notes of patients with recurrent tonsillitis presenting to our department were reviewed retrospectively to check for documentation of the SIGN indication for tonsillectomy. Three audit cycles were carried out, each over a 3‐month period.ResultsPrior to intervention, only 51% (25/51) patients undergoing tonsillectomy had documented evidence of adherence to SIGN guidelines for surgery. Interventions following the first audit cycle included presentation of audit findings, introduction of guideline templates for doctors to complete, and recruitment of medical secretaries to return the notes to doctors if documentation was incomplete. Postintervention, audit cycles 2 and 3 showed respectively 100% (30/30), and 92% (36/39) of patients had documented evidence of adherence.ConclusionThe introduction of a simplistic model of intervention as above improved the local adherence to SIGN guidance for tonsillectomy and translated to safe and better care for patients. This model is easily replicable and can be used in other ENT departments to improve patient care.
Treatment of Lymphatic Malformations: A Systematic Review
Authors: Adams Mary Theresa , Saltzman Babette S. , Perkins Jonathan A. 
Published: September 2011

Objective1) Systematically review the literature pertaining to head and neck (H&N) lymphatic malformation (LM) treatment, and use individual level data presented in qualifying case‐series to compare efficacy, complications, and functional impact among surgery and sclerotherapy. 2) Evaluate whether treatment modalities differed by LM stage.MethodUsing Ovid and search terms lymphangioma, cystic hygroma, and lymphatic malformation, we performed a literature search yielding 6,292 references. Excluding references that did not: involve H&N LM treatment, include at least 5 patients, follow patients for one year, define treatment, and state complications, yielded 29 articles with individual level data.ResultsWe pooled individual case data from case series, indentifying 157 patients treated with surgery and 132 patients treated with sclerotherapy. Advanced stage LM were more likely to be treated with surgery (24 (15.8%)) than sclerotherapy (34 (28.1%)). Advanced stage LM had increased levels of persistence in both surgically treated and sclerosed patients. One sclerotherapy treatment was used in 45 (34%), 2 in 35 (26.5%), and three or more in the remainder. The report of complications and functional impact was inconsistent among papers.ConclusionCurrently no standardized reporting system of LM case series exists, making it difficult to compare treatments. Our data suggest that sclerotherapy may be more efficacious, with fewer side effects than surgery; however, our evaluation did not take into account the potentially confounding effects of LM stage, treatment indications, and complications.
Acetylcysteine in Treatment of Subacute Sinusitis: A Double Blind Placebo Controlled Clinical Trial Study
Authors: Bahtouee Mehrzad , Adibi Hooman , Langroodi Mazyar Motiei 
Published: September 2011

ObjectiveAcetylcysteine (AC) is an antioxidant agent with mucolytic effect and reported to enhance mucosal immunity. Our hypothesis was that adding AC to currently used drugs in patients with subacute sinusitis increases improvement and prevents further complications, such as progression to chronic sinusitis.MethodForty‐five patients with subacute sinusitis were enrolled in trial. All received Amoxicillin‐Clavulanic acid, Pseudoephedrine, and saline drop. In addition patients received AC in the intervention group but placebo in control group. Symptoms and CT findings were assessed at baseline and 45 days after by Snot 20 questionnaire and Lund‐Mackay score.ResultsNo significant improvement was seen in the clinical and radiological findings by adding oral AC to Amoxicillin‐Clavulanic acid, Pseudoephedrine, and nasal saline drop, comparing Snot 20 and Lund‐Mackay score after treatment between groups.ConclusionAdding oral Acetylcysteine to currently used drugs in the treatment of subacute sinusitis has no significant benefit.
Anatomic Access to the Petrous Apex: Comparing Nasal and Lateral Approaches
Authors: Iseli Tim A. , King James , Yahng John , Leung Randal 
Published: September 2011

ObjectiveCompare the anatomic access to the petrous apex via the nasal and lateral approaches using CT reconstructions.MethodA total of 200 consecutive fine cut CT temporal bones performed at Royal Melbourne Hospital from July 27, 2007, to October 30, 2010, were reviewed. Easy lateral access allowed use of a 4mm burr past vital structures. Easy nasal access was when the sphenoid was pneumatized to back of sella/beyond and laterally beyond V2/vidian junction.ResultsEasy surgical access via the lateral approach occurred in 74 sides (37%), with easy access via the supra‐labyrinthine approach occurring in 4 sides (2%) and infra‐labyrinthine approach in 72 sides (36%). Easy surgical access via the nasal approach occurred in 79 sides (39.5%). There was a poor correlation between easy nasal access and easy lateral access (r=0.1011 with P =. 154). 125 (62.5%) had a pneumatized mastoid, and 126 (63%) had a large sphenoid sinus allowing easy surgical access. There was a significant correlation between mastoid and sphenoid pneumatization (P <. 001).ConclusionSurgical access to the petrous apex via the lateral and nasal approaches are limited by tight anatomic confines. Ease of access via one or other approach does not correlate with ease via the other approach. However, pneumatization of the mastoid/ear does correspond to the anatomic size of the sphenoid.