International journal of pediatric otorhinolaryngology
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The role of the pediatric laryngologist has changed. He now manages a greater range of clinical problems in the upper airways. ⋯ It is a precise procedure utilizing a range of modern miniaturized instruments. Major technological improvements include quartz iodine and xenon light sources, flexible light carrying leads, fiberoptic rod lighting, special purpose laryngoscopes, rigid telescopes, versatile techniques of anesthesia, microlaryngeal surgery, laser surgery and reliable photographic documentation.
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Int. J. Pediatr. Otorhinolaryngol. · Oct 1987
Case ReportsNasal obstruction in the neonate secondary to nasolacrimal duct cysts.
The neonate is an obligate nasal breather and any form of nasal obstruction causes respiratory distress during feeding and sleeping. We report two patients with unusual causes of respiratory distress secondary to nasolacrimal duct cysts. ⋯ Removal of the nasal wall of the cyst resolves the obstruction and the dacryocystitis. The nasolacrimal duct cyst is an unusual, but readily treated, cause of neonatal respiratory distress.
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Int. J. Pediatr. Otorhinolaryngol. · Oct 1987
An assessment of preoperative coagulation screening for tonsillectomy and adenoidectomy.
Preoperative coagulation studies are commonly employed in order to try to identify the 2-4% of all patients undergoing tonsillectomy/adenoidectomy surgery who experience hemorrhagic complications. In an atmosphere of increasing cost consciousness, evaluation of the efficacy of screening tests is warranted. The records of 994 out of 1050 patients consecutively scheduled for tonsillectomy, adenoidectomy or T&A over a 2.5-year period were retrospectively reviewed in order to determine the usefulness of partial thromboplastin (PTT) and prothrombin time (PT) screening in predicting surgical and postsurgical bleeding. ⋯ The purpose of any screening test is to identify disease early enough for therapeutic intervention to be effective. Although preoperative PT/PTT will occasionally identify an unsuspected von Willebrand's or other coagulopathy, the prevalence of bleeding disorders in patients with negative history and examination is low enough that PT/PTT has essentially a zero predictive value for surgical bleeding. Screening PT/PTT should therefore be reserved for patients with known or suspected coagulopathies.
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Int. J. Pediatr. Otorhinolaryngol. · Aug 1987
Postoperative complications following tonsillectomy and adenoidectomy--who is at risk?
Postoperative complications following a large series of adenotonsillectomies (784 patients) at the Children's Hospital of Philadelphia fell into two major categories: hemorrhage and airway problems. Bleeding requiring operative intervention occurred in one child in the immediate postoperative period and in 16 children (2.0%) within 7-10 days. Eight patients (1.0%) had minor bleeding requiring only observation, and 9 others (1.2%) reported mild bleeding at home. ⋯ In general, these children were younger and most had significant underlying medical problems. We conclude that many complications encountered after adenotonsillar surgery are intrinsic to the patient's disease and overall medical condition. Improved surgical and anesthetic techniques have minimized the complications noted in earlier studies.
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Three polyvinyl chloride tracheotomy tube (Shiley) failures were seen in two ventilator-dependent children at the University of New Mexico Hospital. In each a defect was noted between the faceplate and the cannula. It is postulated that a loss of plasticity of the polyvinyl chloride could have contributed to these failures. Recommendations for care and re-use of the tracheotomy tube are made.