scholarly journals Changes in Breathing Patterns after Surgery in Severe Laryngomalacia

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1120
Author(s):  
Fabrizio Cialente ◽  
Duino Meucci ◽  
Maria Luisa Tropiano ◽  
Antonio Salvati ◽  
Miriam Torsello ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Tidal Volume ◽  
Surgical Procedure ◽  
Pulmonary Function Tests ◽  
Therapeutic Effects ◽  
Breathing Patterns ◽  
Upper Airways ◽  
Children's Hospital ◽  
Post Surgery ◽  
Children’S Hospital

Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student T-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.

Development of the Spitz—Holter valve in Philadelphia

2001 ◽  
Vol 95 (1) ◽  
pp. 145-147 ◽  
Author(s):  
John A. Boockvar ◽  
William Loudon ◽  
Leslie N. Sutton
Keyword(s):  
Surgical Treatment ◽  
Successful Development ◽  
Shunt Valve ◽  
Content Type ◽  
Children's Hospital ◽  
Fertile Crescent ◽  
Children’S Hospital ◽  
History Of ◽  
The 1950S ◽  
Fine Print

✓ The history of the treatment for hydrocephalus dates back to the Fertile Crescent thousands of years ago. Despite three millennia of management, significant advances in the surgical treatment of the disease have been infrequent. During the 1950s, a milestone occurred at the Children's Hospital of Philadelphia, with the successful development of the first working shunt valve for the treatment of hydrocephalus. In this historical vignette, based on recent interviews with John Holter, D.Sc. (Hon) and Eugene Spitz, M.D., and on a review of the available literature, the authors narrate the exciting story of the development of the Spitz-Holter valve, which took place in Philadelphia during the early 1950s.

Lumbar Disc Disease in Children

Neurosurgery ◽  
1978 ◽  
Vol 2 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Eddy Garrido ◽  
Robin P. Humphreys ◽  
Bruce E. Hendrick ◽  
Harold J. Hoffman
Keyword(s):  
Surgical Treatment ◽  
Clinical Experience ◽  
Lumbar Disc ◽  
Surgical Results ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract The clinical experience with lumbar disc disease in 38 patients at a large children's hospital is reviewed. Thirty children underwent surgical treatment; eight patients were not operated upon. The surgical results were excellent, with 93% of the children cured or markedly improved on follow-up. The main differential aspects of lumbar disc disease between children and adults are emphasized.

scholarly journals Inpatient surgical treatment of paediatric proximal humerus fractures between 2000 and 2012

2018 ◽  
Vol 12 (2) ◽  
pp. 111-116 ◽  
Author(s):  
A. I. Cruz Jr ◽  
J. E. Kleiner ◽  
J. A. Gil ◽  
A. D. Goodman ◽  
A. H. Daniels ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Operative Treatment ◽  
Proximal Humerus ◽  
National Database ◽  
Proximal Humerus Fractures ◽  
Children's Hospital ◽  
Severity Scores ◽  
Children’S Hospital ◽  
Humerus Fractures ◽  
Over Time

Purpose To estimate the rate of surgical treatment of paediatric proximal humerus fractures over time utilizing a large, publicly available national database. Methods The Healthcare Cost and Utilization Project Kids’ Inpatient Database was evaluated between the years 2000 and 2012. Proximal humerus fractures were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes. ICD-9 CM procedure codes were used to identify patients who received surgical treatment. Univariable and multivariable logistic regression were used to determine variables associated with greater proportions of surgical treatment. All statistical analyses were performed utilizing SAS statistical software v.9.4. Statistical significance was set at p < 0.05. Results A total of 7520 proximal humerus fracture admissions were identified; 3247 (43.2%) were treated surgically. The percentage of patients receiving surgery increased from 39.3% in 2000 to 46.4% in 2012 (p < 0.001). After adjustment for potential confounders, increased age, increased ICD-9 derived injury severity scores (ICISS) and more recent year were associated with an increased proportion of patients receiving surgical treatment (p < 0.001). Medicaid payer status (p < 0.001) and admission to a children’s hospital (p = 0.045) were associated with a lower proportion of surgical treatment. Conclusion The rate of operative treatment of paediatric proximal humerus fractures increased over time between 2000 and 2012. Increased surgical rates were independently associated with older age, increased ICISS, treatment at a non-children’s hospital and non-Medicaid insurance status. Further study is needed to provide evidence to support improved outcomes after operative treatment of paediatric proximal humerus fractures. Level of Evidence IV

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

2008 ◽  
Vol 18 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Lauren Hofmann ◽  
Joseph Bolton ◽  
Susan Ferry
Keyword(s):  
Tracheostomy Tube ◽  
Pediatric Population ◽  
Interdisciplinary Approach ◽  
Extended Period ◽  
Speech Development ◽  
Tube Placement ◽  
Background Information ◽  
Speaking Valve ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

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