Management Patterns in Pediatric Complicated Sinusitis

2020 ◽  
Vol 163 (4) ◽  
pp. 814-821
Author(s):  
Sean M. McDermott ◽  
Amanda Onwuka ◽  
Charles Elmaraghy ◽  
Patrick C. Walz
Keyword(s):  
Medical Therapy ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Early Stage ◽  
Tertiary Care ◽  
Case Series ◽  
Hospital Charges ◽  
Intracranial Extension ◽  
Disease Characteristics ◽  
Outcome Differences

Objectives Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed. Results The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens ( P = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients ( P < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS ( P = .92). Conclusion Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.

scholarly journals Anterior Segment Findings in Ocular Myocysticercosis in Children: Is it non- specific?

2021 ◽  
Vol 13 (1) ◽  
pp. 141-145
Author(s):  
Prabhakar Singh ◽  
Abhishek Gupta ◽  
Richa Gupta
Keyword(s):  
Anterior Chamber ◽  
Surgical Management ◽  
Medical Therapy ◽  
Medical Management ◽  
Extraocular Muscle ◽  
Pediatric Patients ◽  
Early Stage ◽  
Anterior Segment ◽  
Case Series ◽  
Ocular Cysticercosis

Ocular cysticercosis is a preventable cause of blindness. Medical therapy has been recommended for the retro-orbital and extraocular muscle form. Surgical management is largely done in cases with conjunctival or lid affliction. Though, the medical management is simple; however, the diagnosis is challenging. The anterior segment findings often mimic the more common pathologies and hence often missed at the early stage. This case series of 3 pediatric patients, tries to highlight certain clinical clues which are suggestive of ocular myocysticercosis in children. Literature often recalls anterior segment findings in ocular myocysticercosis as “non- specific and nondiagnostic”. Canthal congestion and contiguous conjunctival congestion extending upto corresponding limbal border in absence of anterior chamber inflammation with other clinical clues are very suggestive of corresponding recti myocysticercosis.

scholarly journals Masses of the Sternoclavicular Area: Case Series and Review of the Literature

2021 ◽  
Vol 15 ◽  
pp. 117955652110216
Author(s):  
Parisa Oviedo ◽  
Morgan Bliss
Keyword(s):  
English Language ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Case Series ◽  
Review Of The Literature ◽  
Incision And Drainage ◽  
Surgical Interventions ◽  
Ganglion Cysts ◽  
Icd 10 ◽  
Bronchogenic Cysts

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients. Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed. Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest. Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

scholarly journals Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

2020 ◽  
Author(s):  
Aidan Sharkey ◽  
Ronny Munoz Acuna ◽  
Kiran Belani ◽  
Ravi K Sharma ◽  
Omar Chaudhary ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
Vena Cava ◽  
Case Series ◽  
High Morbidity ◽  
Severe Tricuspid Regurgitation ◽  
Maximal Medical Therapy ◽  
Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

Outcomes In Pediatric Endoscopic Skull Base Surgery: A Systematic Review

2021 ◽  
Author(s):  
Erin Mamuyac Lopez ◽  
Zainab Farzal ◽  
Kelly Marie Dean ◽  
Craig Miller ◽  
Justin Cates Morse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Csf Leak ◽  
Inclusion Criteria ◽  
Endoscopic Skull Base Surgery ◽  
Tertiary Care Medical Center

Objectives: The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study’s aim is to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents ages 0-18 years. Design: A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000-2020 using PRISMA guidelines. Final inclusion criteria included: case series with 10+ patients with pediatric patients age ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting: Tertiary care medical center Participants: Children/adolescents ages 0-18 years who underwent endoscopic skull base surgery Main Outcome Measures: Patient demographics, pathology, reconstructive technique, intra-operative findings, intra-operative and post-operative surgical complications. Results: Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients age 0-18 years met inclusion criteria for final analysis. 7 of 12 studies discussed a single pathology. The most common pathology was a skull base defect causing CSF leak. The majority of skull base repairs were made with free tissue grafts. The most common post-operative complication was CSF leak (n=40). Twelve cases of meningitis occurred post-operatively with two of these episodes resulting in death. Conclusions: Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

Early Surgical Intervention for Fulminant Pseudomembranous Colitis

2008 ◽  
Vol 74 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Syed O. Ali ◽  
John P. Welch ◽  
Robert J. Dring
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Pseudomembranous Colitis ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Case Series ◽  
Hemodynamic Instability ◽  
Blood Cell Count

The objective of this study of a retrospective case series was to determine factors associated with survival after surgical intervention in pseudomembranous colitis (PMC). The study was conducted at a tertiary care medical center and comprised 36 patients who underwent colectomy for fulminant PMC from 1995 to 2006. Patients including 21 females ranged from 40 to 89 years of age (mean, 70 years). Comorbidities included diabetes (39%), cardiovascular disease (77%), chronic obstructive pulmonary disease (47%), and intake of immunosuppressive medications (45%). Seventy-two per cent received antibiotics in the previous 2 months. Only patients with a confirmation of PMC on pathology specimens were included in the study. All patients underwent colectomy. Patients were stratified into two groups: survivors and nonsurvivors. Various clinical factors/parameters used in the management of patients with PMC were studied in these two groups. Survival was correlated with mean white blood cell count (23,000 survivors versus 40,000 nonsurvivors, P < 0.01); multisystem organ failure (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05); and preoperative pressors (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05). Overall mortality for the study period was 47 per cent. Mortality rate analysis revealed a lower rate for the more recent years (32 per cent for 2000 to 2006 versus 65 per cent for 1995 to 1999, P < 0.05). In the more recent years, the time elapsing before colectomy was also lower (1.4 days versus 2.5 days, nonsignificant), and patients had less preoperative hemodynamic instability (70 per cent versus 31 per cent, P < 0.03). In one institution, survival after surgery for PMC was found to be associated with a mean white blood cell count (<37,000), nondependence on preoperative vasopressors, and surgical intervention before the onset of hemodynamic instability.

Pediatric Tracheostomy Decannulation: 11-Year Experience

2019 ◽  
Vol 161 (3) ◽  
pp. 499-506 ◽  
Author(s):  
Kristen L. Seligman ◽  
Bryan J. Liming ◽  
Richard J. H. Smith
Keyword(s):  
Failure Rate ◽  
Chart Review ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Late Failure ◽  
Final Study ◽  
Study Population ◽  
Tertiary Care Institution

Objective To determine the successful decannulation rate with a published pediatric tracheostomy decannulation protocol. Study Design Case series with chart review. Setting A single tertiary care institution. Subjects and Methods A chart review was performed for patients aged ≤5 years who underwent tracheostomy. Extracted data included demographic data, indication for tracheostomy, age at tracheostomy and decannulation, comorbidities, and surgical complications. Records were searched for documentation of early decannulation failure (within 1 month of decannulation) or late failure (within 1 year). Results Forty patients with a tracheostomy aged ≤5 years underwent attempted decannulation during the 11-year study period. Seventeen patients were excluded from the study for documentation of nonprotocol decannulation. The final study population of 23 patients underwent a total of 27 decannulations, 26 of which were performed by protocol. Of the 26 protocol decannulations, 22 were successful, for a failure rate of 15%. Conclusion Twenty-six protocol decannulations were attempted among 23 patients, 4 of which were unsuccessful for an overall failure rate of 15%. This result is consistent with rates reported in other published decannulation protocols. We believe that our protocol minimizes resource utilization in its use of pulse oximetry over polysomnography, while maximizing patient safety and success through the use of capping trials for very young and very small pediatric patients.

Intracranial and Orbital Complications of Sinusitis: A Case Series and Review of Literature

2011 ◽  
Vol 4 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Kishore Shetty ◽  
Vinay Vaidyanathan
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Interesting Case ◽  
Sinus Surgery ◽  
Intracranial Extension ◽  
Review Of Literature ◽  
Neurosurgical Technique ◽  
Orbital Complications ◽  
Late Recognition

ABSTRACT Complications of paranasal sinus infection most often involve the orbit and periorbita. Because of widespread use of antibiotics, intracranial extension of paranasal sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential of these complications, as late recognition of this condition and delay in treatment can increase morbidity and mortality rates. An interesting case series of sinusitis with orbital and intracranial complication is presented, which was radiologically evaluated, and was managed by endoscopic sinus surgery with drainage of subdural empyema by appropriate neurosurgical technique. The radiological tools played a very important role in both assessment and timing of surgical intervention. Unparallel role of radiological investigations cannot be overemphasized. The key to successful treatment is aggressive management and the timing for surgical intervention should not be deferred. The patients made full recovery at the time of discharge.

scholarly journals A Conscious Sedation Protocol for Videolaryngostroboscopy in Pediatric Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Samantha Anne ◽  
Lawrence M. Borland ◽  
Laura Haibeck ◽  
Joseph E. Dohar
Keyword(s):  
Outcome Measures ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Case Series ◽  
Diagnostic Information ◽  
Secondary Outcome ◽  
Sedation Protocol

Objective. To determine best sedation protocol for videolaryngostroboscopy in children unable to tolerate non-sedated evaluation.Materials and Methods.Consecutive case series of 10 children with voice disturbances, unable to tolerate nonsedated videolaryngostroboscopy at an academic tertiary care children’s hospital. Flexible fiberoptic videolaryngostroboscopy was performed and interpreted by pediatric otolaryngologist and speech and language pathologist. Sedation was administered with newly described protocol that allowed functional portion of evaluation.Main Outcome Measures: ability to follow commands and tolerate flexible fiberoptic videolaryngostroboscopy.Secondary Outcome Measures: total phonation time, complications, need for subsequent videolaryngostroboscopic attempts, clinical outcomes, and follow-up.Results. 10 children underwent procedure under conscious sedation. 9/10 children were able to perform simple tasks and maintain adequate phonation time to complete stroboscopic exam. 1/10 patients failed to complete exam because of crying during entire exam. Mean exam time was 2 minutes 52 seconds (SD 86 seconds), phonation time is 1 minute 44 seconds (SD 60 seconds), and number of tasks completed was 10.5 (SD 8.6).Conclusions. Conscious sedation for videolaryngostroboscopy can be safely and effectively performed in children unable to comply with nonsedated examination. Such studies provide valuable diagnostic information to make a diagnosis and to devise a treatment plan.

scholarly journals 1132. Evaluation of Broad-Spectrum Antimicrobial Therapy for Acute Mastoiditis in Pediatric Patients: An Antimicrobial Stewardship Perspective

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S402-S403
Author(s):  
Soyoon Kim ◽  
Brady Moffett ◽  
Beth Pali ◽  
Jill D’Souza ◽  
Ankhi Dutta
Keyword(s):  
Pediatric Patients ◽  
Surgical Intervention ◽  
Clinical Laboratory ◽  
Group A Streptococcus ◽  
Acute Otitis Media ◽  
Tube Placement ◽  
Intracranial Extension ◽  
Acute Mastoiditis ◽  
Antimicrobial Management ◽  
Group A

Abstract Background Acute mastoiditis (AM) continues to remain a serious complication of acute otitis media in children. There is a significant variation in antimicrobial management in children with AM. Recent studies and UptoDate recommends empiric coverage with vancomycin and antipseudomonal medication in patients with AM. The purpose of this study was to evaluate the epidemiology, management and outcome of AM in pediatric patients. Methods A retrospective, observational study was designed evaluating epidemiology and management of AM in hospitalized pediatric patients from July 1, 2011 to June 30, 2017. Patients between 6 months and 19 years of age admitted with a diagnosis of AM as per ICD 9/10 coded were included in the study. Information regarding demographic, clinical, laboratory, microbiological, radiological, antibiotic (Abx) usage, surgical intervention and outcome were collected from medical records. Results A total of 97 patients were evaluated (64% male, mean age 6.6 ± 4.3 years). Cultures (Cx) were obtained in 95 patients as in Figure 1. Of the patients who grew P.aeroginosa, 2 had intracranial extension, both of which were polymicrobial and 5 did not receive empiric antipseudomonal therapy but had no complications on follow-up. Table 1 shows the most common empiric Abx therapy. Fifty-nine patients (61.5%) had a change in Abx, the most common being a ceftriaxone or a combination of clindamycin and ceftriaxone. Except for those with complicated AM, none required definitive vancomycin therapy. Thirty-two patients (33%) had a complicated mastoiditis with epidural abscess, thrombosis, and/or intracranial extension. Eighty-six patients (86.8%) required surgical intervention. Mastoidectomy was performed in 34% while others had myringotomy and tympanostomy tube placement and/or drainage of subperiosteal abscesses without subsequent complications. Conclusion Group A Streptococcus, Streptococcus pneumoniae and Pseudomonas were the predominant pathogens in acute AM in children. Vancomycin and empiric antipseudomonal coverage may not be needed in patients with uncomplicated AM. Broader spectrum Abx with intracranial penetration should be reserved for those with complicated AM. Disclosures All authors: No reported disclosures.

A Case Series of the Probability Density and Cumulative Distribution of Laryngeal Disease in a Tertiary Care Voice Center

2017 ◽  
Vol 126 (11) ◽  
pp. 748-754 ◽  
Author(s):  
Jaime de la Fuente ◽  
C. Gaelyn Garrett ◽  
Robert Ossoff ◽  
Kim Vinson ◽  
David O. Francis ◽  
...  
Keyword(s):  
Probability Density ◽  
Surgical Intervention ◽  
Rank Order ◽  
Tertiary Care ◽  
Diagnostic Category ◽  
Case Series ◽  
Cumulative Distribution ◽  
Structural Abnormality ◽  
Pareto Analysis ◽  
Laryngeal Disease

Objective: To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice. Methods: Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period. Results: Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%). Conclusions: Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.

Sign in / Sign up

Export Citation Format

Share Document