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Michael J Rutter

Publications and source records attributed to Michael J Rutter.

27 records · Page 2Linked to original sources
PubMed2004

Chronic esophageal foreign bodies in pediatric patients: a retrospective review.

OBJECTIVE: Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. METHODS: We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children's Hospital Medical Center, Cincinnati, OH, between May 1990 and January 2002. A chronic esophageal foreign body was defined as a foreign body estimated to have been present for over 1 week. RESULTS: Over the inclusion period, 522 children were admitted with esophageal foreign bodies, 41 (8%) of which were chronic. The most common foreign bodies were coins. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea/vomiting and dysphagia. One patient was asymptomatic on presentation. A perforated esophagus was identified in 18 patients, with 17 of these being a technically perforated esophagus and one case being a classic esophageal perforation. There were no deaths or permanent morbidity in this series. CONCLUSIONS: Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with chronic esophageal foreign bodies. Removal by rigid esophagoscopy is recommended. A small proportion of cases require open removal of the foreign body. Conservative management is appropriate for the technically perforated esophagus. A good outcome should be anticipated for the majority of cases.

Adolescent↗
PubMed2004

Association of anterior glottic webs with velocardiofacial syndrome (chromosome 22q11.2 deletion).

OBJECTIVE: An association between anterior glottic webs and velocardiofacial syndrome (chromosome 22q11.2 deletion) has previously been noted in a number of case reports. Our objective was to determine if the presence of such webs warrants a high index of suspicion for this chromosome deletion. Study design and setting This study was carried out in the Division of Pediatric Otolaryngology-Head and Neck Surgery at Cincinnati Children's Hospital Medical Center. Chromosome 22q11.2 deletion status was determined for all patients endoscopically diagnosed with anterior glottic webs between July 1998 and December 2000. Families of patients who tested positive for the deletion were referred to the Cincinnati Children's Division of Human Genetics for additional evaluation and counseling. RESULTS: Eleven of 17 patients (65%) with anterior glottic webs were positive for chromosome 22q11.2 deletion. Of these 11 patients, 5 showed subtle clinical manifestations of velocardiofacial syndrome and underwent genetic testing due only to the presence of a web. All 11 patients were diagnosed with velocardiofacial syndrome. CONCLUSION: We strongly recommend that all patients diagnosed with anterior glottic webs undergo fluorescence in situ hybridization evaluation for this chromosome deletion.

Child↗
PubMed2004

Pediatric suprastomal granuloma: management and treatment.

OBJECTIVE: Suprastomal granulomas (SSG) are a common complication of pediatric tracheotomy. Occasionally excision is indicated for obstructive granulomas. We report on our experience on the management of SSG requiring excision. Study design and setting A retrospective chart review of 68 patients who underwent SSG excision at a tertiary referral pediatric hospital between July 1997 and November 2002. The medical charts were reviewed for excision techniques and outcomes. RESULTS: A total of 106 excisions of SSG were performed on 68 patients. Of the patients, 25 (36.8%) required multiple excisions. Removal techniques included sphenoid punch (34.9%), optical forceps (34.0%), open excision (22.6%), electrocautery (4.7%), and hook and eversion (3.8%). CONCLUSION: The majority of SSG do not require removal. If excision is indicated, we recommend using optical forceps for soft and friable lesions and the sphenoid punch for fibrous and firm granulomas. For granulomas that have a broad base, are very large, or where endoscopic instrumentation is not possible, we recommend open excision.

Adolescent↗
PubMed2004

Complications of metallic stents in the pediatric airway.

OBJECTIVE: Our aim was to present our experience with complications caused by placement of metallic stents in the pediatric airway. DESIGN AND SETTING: We conducted a retrospective study of the medical records of patients with complications resulting from metallic stent placement, managed by the senior authors between 1993 and 2002. RESULTS: Nine children had complications associated with the placement of metallic airway stents. Of these, 8 children required stent removal. Granulation tissue and tracheal stenosis were seen in all 7 children with long standing stent placement. There was 1 stent death in this series. CONCLUSIONS: Metallic airway stents can cause significant complications in the pediatric airway. These complications may supersede the airway compromise that necessitated their initial placement. As such, metallic stent placement should be approached with caution. The likelihood and severity of complications increase with time, as do the difficulties encountered upon removal. The proportion of patients in whom metallic stents may be placed "permanently" without complications is not known. Therefore we recommend that metallic airway stents be considered a temporizing measure of limited duration.

Child, Preschool↗
PubMed2004

Bacterial tracheitis reexamined: is there a less severe manifestation?

OBJECTIVE: Bacterial tracheitis (BT) is a condition that can cause fatal airway obstruction. We evaluated our experience with BT over a 10-year period. STUDY DESIGN: Retrospective review of patients treated for BT between 1991 and 2001. RESULTS: Ninety-four cases were evaluated. The mean patient age was 7.9 years. At presentation, 60% were afebrile, and the mean WBC count was 10.8 x 10(3)/mm3 . Only 53% of patients required intubation. Younger children were more likely to require this intervention. S. aureus was the most commonly cultured bacteria, while isolation of M. catarrhalis was associated with a higher intubation rate. A pathologic virus was isolated in 64% of the 34 cultures performed. Only 9 patients were described as "toxic," and 6 presented in respiratory extremis. There were no deaths. CONCLUSION AND SIGNIFICANCE: A subset of patients with tracheal membranes has a less severe clinical appearance. Nonetheless, these patients require debridement and aggressive medical treatment. We propose that the term "exudative tracheitis" (ET) better describes this entity. Older patients who are less systemically ill and rapidly respond to local and systemic therapy are characteristic of ET. EBM RATING: C.

Adolescent↗
PubMed2004

Intrapartum management of severe fetal airway obstruction.

OBJECTIVE: To review our experience with the planned intrapartum management of fetuses with suspected severe airway obstruction. METHODS: Retrospective review of prenatal presentations, intrapartum airway procurement methods, outcomes, and complications. RESULTS: All cases (N = 11) at our tertiary airway referral institution between 1995 and 2002 were reviewed. Obstruction was secondary to giant cervicofacial lymphangiomas (5), teratomas (2), epignathis (1), epulis (1), conjoined fetus (1), and tracheal foreign body (1). Elective cesarean delivery of the entire fetus was performed while maintaining fetal-placental circulation as long as possible. We found it necessary to deliver the entire fetus to improve airway exposure and decrease maternal hemorrhage. The airway was secured effectively in all cases. CONCLUSIONS: Although full cesarean delivery of the fetus significantly reduces fetal-placental circulation times, in comparison with the formal ex utero intrapartum treatment (EXIT) procedure, airway access is improved, maternal complications may be decreased, and high airway procurement success is still safely achieved.

Airway Obstruction↗
PubMed2003

Slide tracheoplasty for the management of complete tracheal rings.

BACKGROUND/PURPOSE: Although rare, complete tracheal rings are the most common cause of congenital tracheal stenosis. The last 2 decades have seen an evolution in management, with increasing awareness of the potential advantages of slide tracheoplasty. METHODS: Between March 2001 and August 2002, 11 children had complete tracheal rings corrected by slide tracheoplasty. Ages ranged from newborn to 15 years, and weight ranged from 1.8 to 57 kg. Length of stenosis ranged from 3 rings to virtually the whole length of the trachea. The most narrow point in the airway varied from less than 1.9 mm to 4.8 mm. Eight children had other congenital anomalies, severe in one child. Most children underwent repair on cardiopulmonary bypass. RESULTS: Nine children are asymptomatic or minimally symptomatic, although 2 have endoscopic evidence of mild residual tracheal stenosis. One child, who had been unstable pre-operatively, died of multiple organ failure 7 weeks postoperatively. A second child required a tracheotomy for bronchomalacia at 6 months and died at 9 months with tracheotomy tube occlusion. Both children had adequate tracheal repairs. Complications have included lateral tracheal stenosis (the "Figure 8" trachea) and recurrent laryngeal nerve damage. CONCLUSIONS: Our management of complete tracheal rings has evolved over the last decade, and slide tracheoplasty currently is our preferred surgical approach for tracheal stenosis regardless of the length of narrowing.

Adolescent↗
PubMed2003

Current airway management in craniofacial anomalies.

PURPOSE OF REVIEW: Airway obstruction requiring intervention occurs frequently among children with craniofacial anomalies. The presence of a craniofacial anomaly is a common reason for tracheotomy in the pediatric population. Because of the complications associated with tracheotomy, however, numerous other methods have been proposed to alleviate severe airway obstruction in this patient population. RECENT FINDINGS: Nonsurgical management of airway obstruction remains the initial treatment option in children with craniofacial abnormalities; however, a significant number of patients fail to respond to this management strategy. Perhaps the most significant recent alternative airway management technique is the use of distraction osteogenesis to advance the mandible and maxilla. This technique has been used both to achieve early decannulation and to avoid a tracheotomy in infants and children with craniofacial anomalies. SUMMARY: Multiple options exist for relieving upper airway obstruction in craniofacial patients, and the application of these treatment strategies is dependent on the patient's disease and the philosophy of the treating institution. Future research into the management of airway obstruction in children with craniofacial anomalies will need to focus on predicting which children will benefit from conservative management and which children will need distraction osteogenesis or a tracheotomy.

Airway Obstruction↗