1/21. Late presentation of upper airway obstruction in Pierre Robin sequence.A retrospective review was carried out of 11 consecutive patients with the Pierre Robin sequence referred to a tertiary paediatric referral centre over a five year period from 1993 to 1998. Ten patients were diagnosed with significant upper airway obstruction; seven of these presented late at between 24 and 51 days of age. failure to thrive occurred in six of these seven infants at the time of presentation, and was a strong indicator of the severity of upper airway obstruction. growth normalised on treatment of the upper airway obstruction with nasopharyngeal tube placement. All children had been reviewed by either an experienced general paediatrician or a neonatologist in the first week of life, suggesting that clinical signs alone are insufficient to alert the physician to the degree of upper airway obstruction or that obstruction developed gradually after discharge home. The use of polysomnography greatly improved the diagnostic accuracy in assessing the severity of upper airway obstruction and monitoring the response to treatment. This report highlights the prevalence of late presentation of upper airway obstruction in the Pierre Robin sequence and emphasises the need for close prospective respiratory monitoring in this condition. Objective measures such as polysomnography should be used, as clinical signs alone may be an inadequate guide to the degree of upper airway obstruction.- - - - - - - - - - ranking = 1keywords = airway obstruction, obstruction, airway (Clic here for more details about this article) |
2/21. celiac disease presenting as entero-enteral intussusception.Cramping abdominal pain with intermittent intestinal obstruction finally prompted investigation in a 4 1/2-year-old boy with severe failure to thrive (FTT). An entero-enteric intussusception was corrected, and celiac disease was identified as the cause of his inanition. Concomitant FTT and cramping abdominal pain should prompt investigation for celiac disease and small-bowel intussusception.- - - - - - - - - - ranking = 0.0040356154082866keywords = obstruction (Clic here for more details about this article) |
3/21. Vallecular cyst: a cause of failure to thrive in an infant.Congenital vallecular cyst is fairly uncommon in neonates and infants. Although benign in nature, it may cause stridor and even life-threatening airway obstruction in early infancy. A 3-month-old male baby presented with failure to thrive and respiratory distress was found to have a vallecular cyst. Marsupialization with CO(2) laser was performed.- - - - - - - - - - ranking = 0.090542216781065keywords = airway obstruction, obstruction, airway (Clic here for more details about this article) |
4/21. Reversible secondary pseudohypoaldosteronism due to pyelonephritis.We report a 5-week-old boy who developed severe hyponatremia and hyperkalemia secondary to acute pyelonephritis. The patient presented with non-specific signs, including poor appetite, failure to thrive, and dehydration. An endocrinological evaluation led to a diagnosis of pseudohypoaldosteronism. The patient had phimosis, but no congenital urinary tract malformations. Outflow obstruction secondary to the phimosis appears to have caused pyelonephritis, and renal inflammation decreased responsiveness to aldosterone transiently.- - - - - - - - - - ranking = 0.0040356154082866keywords = obstruction (Clic here for more details about this article) |
5/21. failure to thrive caused by the coexistence of vallecular cyst, laryngomalacia and gastroesophageal reflux in an infant.Vallecular cyst is a rare but dangerous cause of stridor in neonates and young infants. Without recognition and proper therapy, the resulting airway obstruction can lead to serious morbidity and mortality. We herein report a young infant with a vallecular cyst synchronous with laryngomalacia and gastroesophageal reflux. The infant initially presented with signs and symptoms mimicking more benign laryngomalacia. Diagnosis was delayed with accompanying failure to thrive. The cyst was revealed by a barium esophagogram and confirmed by flexible bronchoscopy. Laryngomicrosurgery with CO(2) laser not only removed the cyst, but resolved the co-existing laryngomalacia and gastroesophageal reflux as well. After surgery, the infant was symptom free and exhibited a steady weight gain. There was no recurrence during 1 year of follow-up. We have reviewed the literature for this rare and potentially devastating lesion.- - - - - - - - - - ranking = 0.090542216781065keywords = airway obstruction, obstruction, airway (Clic here for more details about this article) |
6/21. Anomalous congenital band: a rare cause of intestinal obstruction and failure to thrive.intestinal obstruction caused by an anomalous congenital band is very rare in adults and children. A 7-year-old boy was admitted with acute intestinal obstruction. His parents mentioned that the child always had mild abdominal distention and failure to thrive from his infancy. On his medical history, there were not any attacks of abdominal pain, fever and hospitalization. laparotomy showed an ileal loop compressed by an anomalous band, which extended from the ileum to the sigmoid mesentery resembling a mesenteric remnant. The band was resected. Histologically, it was composed of loose connective tissue containing mature vessels.- - - - - - - - - - ranking = 0.024213692449719keywords = obstruction (Clic here for more details about this article) |
7/21. Supracardiac total anomalous pulmonary venous connection with a supramitral ring: a rare, surgically correctable anomaly.Total anomalous pulmonary venous connection is rarely associated with a supramitral ring. This condition should be suspected in any infant having total anomalous pulmonary venous connection with obstruction to the pulmonary venous return. Preoperative echocardiography is usually successful in detecting the lesion. The Shumaker and King repair for total anomalous pulmonary venous connection is most appropriate for such composite lesions as it enables the surgeon to identify the membrane and excise it easily and completely. We report one such case.- - - - - - - - - - ranking = 0.0040356154082866keywords = obstruction (Clic here for more details about this article) |
8/21. A 5-month-old boy with recurrent respiratory infections, failure to thrive, and borderline elevated sweat chloride levels.Both severe combined immunodeficiency (SCID) and cystic fibrosis (CF) may present in infancy with a history of respiratory infections and failure to thrive. Elevated sweat chloride levels on multiple sweat tests is diagnostic of CF; transient elevation of sweat chloride has been reported in patients with hypogammaglobulinemia and antibody deficiency without CF. This article presents a case report of a 5-month-old boy with recurrent respiratory infections, failure to thrive, and two borderline elevated sweat test levels. Laboratory evaluation including testing for CF as well as immune deficiency was performed in this patient. Two borderline abnormal sweat chloride tests together with isolation of pseudomonas from the airway caused clinicians initially to suspect CF; however, mutation in gene coding for the gamma-chain of the IL-2 receptor and a negative CF genetic mutation analysis ultimately led to the final diagnosis of SCID. It is essential to make the diagnosis of SCID as early as possible because infants with SCID who do not undergo reconstitution of their immune system universally die in infancy because of infection. early diagnosis and intervention can lead to an excellent prognosis in a previously fatal disease.- - - - - - - - - - ranking = 0.0023572156682281keywords = airway (Clic here for more details about this article) |
9/21. Detection of sleep associated dysfunctional pharyngeal obstruction in infants.Six infants were referred with symptoms and clinical signs suggesting airway obstruction during sleep. In each case, overnight recordings of arterial oxygen saturation, respiratory movements and end tidal expired carbon dioxide (ETCO2) showed the presence of abnormal episodes of hypoxaemia related to partial or complete airway obstruction and associated with a specific pattern of the inspiratory movement waveforms. These events and patterns were not found on recordings from 20 age-matched healthy infants and young children. ETCO2 levels were also abnormally elevated in all six patients when asleep. Fiber-optic upper airway endoscopy excluded structural abnormalities, including significant tonsillar or adenoidal enlargement, but showed an intermittent dysfunctional inspiratory obstruction in the pharynx. Continuous positive airways pressure and tracheostomy were effective in treating this obstruction.- - - - - - - - - - ranking = 0.21001255734831keywords = airway obstruction, obstruction, airway (Clic here for more details about this article) |
10/21. The effect of palatoplasty on airway patency and growth in infants with clefts and failure to thrive.We monitored respiratory patterns, transcutaneous PO2 (tcPO2) and transcutaneous PCO2 (tcPO2) in three infants with clefts and severe failure to thrive. Unexplained dysphagia, muscular weakness and cardiac enlargement were other prominent symptoms. During sleep, repeated obstructive apneas accompanied by significant hypoxemia (tcPO2 less than 6 kPa) were recorded in all infants. Relief of the respiratory obstructions by means of nasopharyngeal intubation led to rapid growth catch-up and disappearance of the cardiac and gastrointestinal symptoms. This improvement in clinical condition was paralleled by an increase in transcutaneous PO2. Palatal closure according to Veau-Wardill-Killner led to a marked decrease in the number of airway obstructions and a significant improvement in blood gas homeostasis. The clinical condition of the infants was equally improved. We suggest that a respiratory investigation should be performed in infants with clefts and poor growth in spite of adequate caloric intake. Early closure of the palate should be considered in infants with signs of a respiratory failure.- - - - - - - - - - ranking = 0.10400669486226keywords = airway obstruction, obstruction, airway (Clic here for more details about this article) |
| | Next -> |