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Biomedical subjects

Kevin D Pereira

Publications and source records attributed to Kevin D Pereira.

13 recordsLinked to original sources
PubMed2006

Bronchoscopy assisted neonatal tracheostomy (BANT): a new technique.

Neonatal tracheostomy is a complex procedure associated with significant morbidity due to the small size and medical condition of the patient. Standard techniques have been well described and depend on palpation and visual identification of the trachea in the wound. This can at times be exceedingly difficult depending on the anatomical configuration of the neck. The potential for damage to adjacent neurovascular structures increases as dissection strays away from the midline. We describe a new technique that restricts dissection strictly to the midline and ensures accurate placement of the tracheostomy below the first tracheal ring. We feel that this technique will significantly shorten the operative time for the procedure and also reduce the morbidity associated with it.

Bronchoscopes↗
PubMed2006

Sequelae of recurrent laryngeal nerve injury after patent ductus arteriosus ligation.

OBJECTIVES: To prospectively study the clinical course of neonates with vocal cord paralysis (VCP) after patent ductus arteriosus (PDA) ligation. METHODS: A prospective cohort study of all premature infants undergoing PDA ligation from March 2001 to February 2004. Flexible laryngoscopy was performed after extubation to assess vocal cord function. Data regarding patient characteristics, operative findings, post-operative endoscopic findings, and the subsequent clinical course were collected. RESULTS: One hundred patients were enrolled. Flexible laryngoscopy was performed on 61 patients. Median birth weight was 740 g, gestational age 25 weeks, and age at operation 23 days. Flexible laryngoscopy was performed at an average of 8 days after extubation. Seven cases of vocal cord paralysis were identified. Two had stridor and feeding difficulty requiring nasogastric feeding. Five of the seven had an average follow-up of 9 months after surgery. At last follow-up, endoscopically satisfactory compensation by the normal vocal cord was observed in all five patients. No patient had feeding problems. CONCLUSIONS: The majority of infants who can be successfully extubated after PDA ligation tend to be asymptomatic despite vocal cord paralysis. Compensation appears to occur rapidly, and patients generally have no *long-term problems with the airway or feeding.

Ductus Arteriosus, Patent↗
PubMed2006

Piriform sinus tracts in children.

OBJECTIVES: To describe the various presentations and management of piriform sinus tracts in children and to provide a treatment algorithm. DESIGN: Case series. SETTING: Pediatric otolaryngology service in a tertiary care setting. PATIENTS: Eight pediatric patients diagnosed as having a piriform sinus tract between 1999 and 2005. INTERVENTIONS: Patients were treated with surgical excision, endoscopic cauterization, or observation. MAIN OUTCOME MEASURE: Recurrence of neck infection. RESULTS: Three different modes of presentation were identified. Four patients presented primarily with an intrathyroidal abscess; 2 presented with recurrent deep neck infections requiring repeated drainage; and 2 presented with symptoms unrelated to the tract. Barium swallows identified the tracts in 5 of 8 patients, and telescopic hypopharyngoscopy identified the tracts in all 8 patients. Five patients were treated with complete excision of their tracts; 1 was treated with cauterization of the internal opening; and 2 were observed for symptoms related to the tracts. All 8 patients are currently asymptomatic. CONCLUSIONS: Piriform sinus tracts are rare. Most patients with tracts present with recurrent deep neck infections. Telescopic hypopharyngoscopy is the diagnostic modality of choice. Endoscopic cauterization is recommended as the initial therapy in symptomatic patients, with complete excision reserved for recurrences. Observation is appropriate for asymptomatic patients.

Branchial Region↗
PubMed2006

Sleep-disordered breathing in children: survey of current practice.

OBJECTIVES: The American Academy of Pediatrics recommends objective testing with polysomnography (PSG) before adenotonsillectomy for sleep-disordered breathing (SDB) in children. Several studies have also shown that a clinical diagnosis correlates poorly with the presence or severity of SDB as confirmed by PSG. The purpose of this study was to examine surgical practice patterns among members of the American Society of Pediatric Otolaryngologists (ASPO). METHODS: A questionnaire was sent electronically to all members of ASPO asking about demographics, PSG facilities, and pre- and postoperative management of children with SDB. RESULTS: A total of 245 questionnaires were sent, and 105 (43%) were completed. The results of the survey show that up to 50% of pediatric visits in individual practices were for SDB. Only 10% of children who underwent adenotonsillectomy had PSG, and the most common reason to request it was doubt about diagnosis. The average wait for PSG was 3 to 6 weeks. Preoperative PSG was routinely requested in children under 1 year of age and children with morbid obesity, craniofacial abnormalities, or neuromuscular disease. The majority of pediatric otolaryngologists proceeded with an adenotonsillectomy in symptomatic children with normal PSG findings. Postoperative PSG was requested in less than 5% of children. Approximately 20% of children who underwent adenotonsillectomy for suspected SDB were observed overnight in hospital. CONCLUSIONS: A majority of respondents from this survey rely on a clinical diagnosis rather than PSG to recommend an adenotonsillectomy for SDB in children. PSG was generally used when the diagnosis was in doubt.

Adenoidectomy↗
PubMed2005

The effect of body position on sleep apnea in children younger than 3 years.

OBJECTIVE: To determine the association between body position and obstructive events during sleep as determined by polysomnography (PSG) in very young children (age, < or = 3 years) with obstructive sleep apnea syndrome. DESIGN: Retrospective chart review. SUBJECTS: Children aged 3 years and younger who underwent PSG to evaluate obstructive sleep apnea and subsequently underwent adenotonsillectomy between December 1, 2000, and November 30, 2003, were included in the study. The PSGs were analyzed for data on the respiratory disturbance index (RDI), time spent in each body position, number of apneic events in each position, oxygen saturation, and time spent in each stage of sleep. The results determined the statistical significance of these parameters. RESULTS: Sixty patients satisfied the criteria for inclusion in the study. The mean supine sleep RDI was 8.5 compared with 4.9 for the mean nonsupine sleep RDI. The mean RDI increased from 5.6 to 8.5 when more than 50% of the time was spent in supine sleep. There was a further increase to 10.5 when supine sleep increased to 75% of the total sleep time. The mean RDI in rapid eye movement sleep was 20.5 compared with 5.3 in non-rapid eye movement sleep. The mean +/- SD supine sleep RDI was 18.5 +/- 5.1, and the mean nonsupine RDI was 7.2 +/- 1.9, which was statistically significant (P = .02). CONCLUSIONS: There is an increase in the RDI with increased time spent in supine sleep in very young children with obstructive sleep apnea. Inadequate time spent in that position may lead to an underestimation of the severity of obstructive sleep apnea. A combination of reduced rapid eye movement sleep and increased nonsupine sleep may invalidate the findings of PSG in these children.

Child Welfare↗
PubMed2005

Ossicular chain dislocation with normal hearing.

We report a unique case of an ossicular chain injury in a young man. Despite the fact that the patient's incus was dislocated into the external auditory canal while remaining attached to the stapes, his hearing was not affected and remained nearly normal. We discuss the patient's presenting features and our diagnostic and management strategy in this case.

Accidents, Traffic↗
PubMed2004

Management of anomalies of the third and fourth branchial pouches.

Third and fourth branchial pouch anomalies are rare and usually present as lateral neck masses, abscesses or with acute suppurative thyroiditis. An opening in the piriform sinus can be identified in most cases. We present four cases of fourth branchial pouch sinuses, one of a third branchial cyst and discuss our management. Cannulation of the sinus tract at laryngoscopy, followed by complete surgical excision, via a modified oblique thyrotomy above the cricothyroid joint after detaching the inferior constrictor was used to treat the fourth branchial pouch anomalies. This surgical approach adequately exposes the piriform sinus apex and also affords protection to the recurrent laryngeal nerve. The third pouch cyst and tract were excised at the level of the thyrohyoid membrane. There were no complications or recurrences.

Abscess↗
PubMed2004

Ameloblastic fibroma of the maxillary sinus.

Ameloblastic fibroma is a rare true mixed tumor of odontogenic origin with both mesenchymal and ectodermal components. It usually arises from the mandibular dentition and presents in the second decade of life. It is a benign slow growing tumor that is less infiltrative than an ameloblastoma but tends to expand bone. It infrequently involves the maxilla and hence the management of these tumors in that region is controversial. The goal of therapy is to avoid cosmetic deformity without compromising on tumor eradication. We present the tenth reported case of this type of tumor in the maxilla, and the second one in an infant.

Humans↗
PubMed2004

Complications of neonatal tracheostomy: a 5-year review.

OBJECTIVE: Study the complication rate of tracheostomy in premature infants and identify contributing factors. Setting Two university-based tertiary care children's hospitals. METHODS: The charts of 55 neonates who underwent tracheostomy between January 1997 and December 2002 were reviewed. Group 1 included 32 infants born weighing < 1000 grams. Group 2 included 23 infants born weighing > or = 1000 grams. RESULTS: Group 1 infants had a higher incidence of comorbidities related to prematurity. Thirty-eight infants underwent tracheostomy due to ventilatory dependence, 13 for airway obstruction, and 4 for neurologic debilitation. Sixteen infants (29%) had a complication related to tracheostomy. There was no tracheostomy-related mortality. CONCLUSIONS: Tracheostomy in the preterm infant has the potential for significant morbidity. Meticulous technique, surgeon experience and specialized care may play a role in reducing the complication rate. Complications are usually minor and do not require additional surgical intervention. EBM RATING: C.

Comorbidity↗
PubMed2003

Community-acquired methicillin-resistant Staphylococcus aureus in children and adolescents: changing trends.

OBJECTIVE: To identify current trends in antibiotic sensitivity patterns of community-acquired methicillin-resistant Staphylococcus aureus (CA MRSA) infections of the head and neck in children and adolescents and evaluate outcomes after therapy. DESIGN: Retrospective review of cases consisting of a medical record review with telephone follow-up. SETTING: Two tertiary university medical referral centers. PATIENTS: Pediatric patients (age <18 years). MAIN OUTCOME MEASURES: Number of cases, sensitivities of cultured organisms, treatments used, and outcome of treatments. RESULTS: Seven patients were identified with CA MRSA in a 4-month period. Superficial abscesses (3 patients [43%]) and suppurative lymphadenitis (3 patients [43%]) were the most common causes. An erythromycin-resistant, clindamycin-sensitive pattern was observed in 6 (86%) of the 7 isolates. All infections resolved with prescribed treatments; there were no complications. CONCLUSIONS: A high prevalence of erythromycin-resistant, clindamycin-sensitive CA MRSA was noted. This new resistance pattern is indicative of inducible macrolide-lincomycin-streptogramin-B resistance. Basic science data suggest that these strains of bacteria could develop resistance to clindamycin during therapy despite appearing susceptible on initial laboratory testing. In our small series, clindamycin was used alone and effectively in 2 such cases. This appears to support its continued use as initial, empiric therapy in suspected cases of CA MRSA.

Adolescent↗
PubMed2003

Tracheostomy in preterm infants: current trends.

OBJECTIVE: To study the indications for and outcomes of tracheostomy in a population of preterm infants. DESIGN: Retrospective analysis of case records. SETTING: Two university-affiliated tertiary care children's hospitals. Patients We identified premature infants who required tracheostomies from January 1, 1997, through January 31, 2001. Information on weight, gestational age, comorbid conditions, indication for tracheostomy, and outcomes was collected. Infants were divided by birth weight into group 1 (<1000 g; n = 19 [very low birth weight]) and group 2 (> or =1000 g; n = 14). Comorbid conditions were scored and a total score was calculated for each patient. RESULTS: Group 1 had a higher incidence of patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity. The incidence of congenital or genetic defects was equal in groups 1 and 2 (11 infants [58%] and 8 infants [57%], respectively). Group 1 had a higher average number of failed extubations (5.17 vs 3.18) and a higher oxygen requirement (48.7% vs 30.3%) compared with group 2. Weight at tracheostomy was essentially equal in groups 1 and 2 (3.6 vs 3.7 kg). Subglottic stenosis and laryngotracheomalacia were equally common findings in groups 1 and 2. The average comorbidity score for group 1 was higher than that for group 2 (6.7 vs 2.8). The most common indication for tracheostomy was ventilatory dependence (n = 24 [73%]), compared with airway obstruction (n = 6 [18%]) and pulmonary toilet (n = 3 [9%]). Overall, 6 patients (18%) had a complication related to the tracheostomy. CONCLUSIONS: Severity of pulmonary disease was the most significant factor associated with the need for tracheostomy in preterm infants. A tracheostomy can safely be performed in these infants with minimal morbidity.

Birth Weight↗