Biomedical subjects

Murali Mahadevan

Publications and source records attributed to Murali Mahadevan.

7 recordsLinked to original sources

PubMed2006

Management of pediatric lateral neck infections: Does the adage "... never let the sun go down on undrained pus ..." hold true?

OBJECTIVES: Pediatric neck infections are frequently treated by Otolaryngologists, Head and Neck surgeons. The relative role of medical versus surgical treatment of pediatric neck infections is debated. The aims of this study are to analyze the management of pediatric neck infections with respect to clinical assessment, radiological assessment and treatment. METHODS: Medical records from January 1999 to June 2005 were reviewed and analyzed. RESULTS: Two hundred and five children with lateral neck infections were included in the study. The clinical diagnosis correlated with the radiology finding in 73.6% with a sensitivity of 28% and a specificity of 92% for lateral neck abscess recognition. The ultrasound finding correlated with the surgical finding in 65.2% with a sensitivity of 70% and a specificity of 33%. When an ultrasound scan was used it changed the intended treatment plan in 10.5% of children. CONCLUSIONS: Accurate clinical assessment of lateral neck infections is poor, generally under estimating suppuration. However, when an abscess is diagnosed clinically this correlates highly with the surgical finding. Radiological assessment has inaccuracy in identifying suppuration and this should be borne in mind when being used as a diagnostic tool for neck infections.

Abscess↗

PubMed2006

A prospective randomised single blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy.

OBJECTIVE: To compare the differences in pain, analgesic use and bleeding in children after tonsillectomy using either a harmonic scalpel or a bipolar diathermy surgical technique. METHODS: Children 6-15 years presenting for tonsillectomy were randomised to either a harmonic scalpel or bipolar diathermy surgical technique. Post-operative pain scores (VAS, 0-10) were recorded within 30 min of surgery and again at the 4h hospital discharge. A subsequent telephone interview daily for 7 days and then every second day until day 13 was used to monitor pain scores, analgesic use and tonsil bed bleeding. RESULTS: There were 204 children studied. The response rate over the first 7 days was 93% for the children in the harmonic scalpel group and 87% for the bipolar group. Children experienced moderate post-operative pain for the first 6 days, after which pain declined from 4-7 to reach a score of 1-2 by day 11. Children undergoing harmonic scalpel tonsillectomy (n=103) reported higher mean pain scores than those who underwent bipolar diathermy (n=101) for current pain (4.7 versus 4.2, p=0.002), worst pain of the day (6.9 versus 6.2, p<0.001) and pain on swallowing (5.9 versus 5.2, p<0.001) over the first 6 post-operative days. Analgesic use (acetaminophen, ibuprofen) was similar in both groups. Hospital readmission for bleeding in children who underwent harmonic scalpel was similar to those who underwent bipolar diathermy tonsillectomy (9% versus 11%) as was bleeding requiring surgical re-exploration (4% versus 2%). CONCLUSIONS: Tonsillectomy was associated with considerable pain for the first 6 post-operative days. Children undergoing harmonic scalpel tonsillectomy had a slight increase in pain compared to the bipolar diathermy group during this time. Both methods of tonsillectomy are effective and safe.

Adolescent↗

PubMed2006

Serious injuries from dishwasher powder ingestions in small children.

AIMS: To describe patterns and severity of caustic injuries sustained from dishwasher powder ingestion and highlight need for national safety standards. METHODS: Retrospective chart review of admissions for caustic ingestion to Starship Children's Hospital from January 2003 to January 2005 and review of New Zealand National Poisons Centre data. RESULTS: Between January 2003 and January 2005, the National Poisons Centre recorded 610 dishwashing powder ingestions, with 88% of children less than 2 years old. Twenty-three children were admitted to Starship Children's Hospital following caustic ingestion, of whom 11 were identified as having ingested dishwasher powder (9 boys and 2 girls) and were aged 11 to 30 months (mean 17.5). Five children (45%) were admitted to the Paediatric Intensive Care Unit over 4 months (October 2004 to January 2005), requiring intubation for airway control. Two children needed tracheostomy. Three of the 11 children (27%) required repeated oesophageal dilatation, and two underwent gastrostomy formation. One brand of dishwasher detergent and container type was implicated in over half of the cases. CONCLUSIONS: Dishwasher detergents are highly corrosive substances that cause potentially life-threatening injuries and ongoing morbidity. The recent surge of incidents may be related to change in product constituents or non-compliance with New Zealand safety standards. Efforts to limit product alkalinity, legislative requirement of Child-Resistant Packaging and public education may reduce injuries from these common household substances.

Accidents, Home↗

PubMed2005

Management of pediatric plunging ranula.

OBJECTIVE: There appears to be a high incidence of ranula in New Zealand. This study was designed to evaluate the diagnosis and surgical treatment of plunging ranula in children at Auckland Starship Children's Hospital, New Zealand. METHODS: A prospective study of 21 pediatric patients with a clinical diagnosis of plunging ranula was conducted. All children underwent clinical assessment and fine needle aspiration cytology. Cytological diagnosis was considered definitive and radiological investigations were not conducted. Surgical treatment comprising intraoral excision of the ipsilateral sublingual gland and pseudocyst was performed. RESULTS: The preoperative diagnosis was unchanged after surgery and histopathological analysis in all cases. There were no recurrences at 24-month follow up. There are no long-term complications to date. CONCLUSIONS: Intraoral removal of the sublingual glands and pseudocyst is an effective and safe method for the treatment of plunging ranula in the pediatric population.

Adolescent↗

PubMed2005

Extensive acquired cholesteatoma in children: when the penny drops.

OBJECTIVES: To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center. METHODS: We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period. RESULTS: There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid. CONCLUSIONS: Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails.

Acute Disease↗

PubMed2004

Day stay pediatric tonsillectomy--a safe procedure.

OBJECTIVE: There is a controversy about day stay pediatric tonsillectomy in the UK and Australia. New Zealand has a similar health structure and we wished to compare day stay tonsillectomy from our hospital with those reported from other centers. METHODS: We performed a prospective audit of day stay tonsillectomy to determine conversion to hospital admission rate and the incidence of postoperative hemorrhage. RESULTS: There were 4850 paediatric tonsillectomies performed with 80% of them as day stay procedures over a 9-year study period (1993-2002) in a university-affiliated tertiary children's hospital. The primary postoperative hemorrhage rate (within 24h of surgery) was 0.9% (CI 0.68-1.22%) and 83% occurred within the mandatory 4h postoperative observation period. Primary hemorrhage requiring re-operation to achieve hemostasis occurred in 18 children (0.37%, CI 0.2-0.54%). No child with a primary hemorrhage who presented after discharge following day stay surgery required re-operation or blood transfusion. Day stay surgery was planned in 4041 children and 4.7% (CI 4.1-5.4%) required conversion to hospital admission. Postoperative vomiting was the most common indication for conversion (2.65%, CI 2.2-3.1%), while hemorrhage contributed only 0.95% (CI 0.64-1.24%). CONCLUSIONS: This study was performed in a health system similar to that of Australia and the UK. Complication and conversion rates are similar to those reported in North American centers. Pediatric day stay tonsillectomy is a safe procedure when performed with strict preoperative criteria, trained day stay unit (DSU) staff, and with in-patient facilities on site.

Adolescent↗

PubMed2004

OK-432 and lymphatic malformations in children: the Starship Children's Hospital experience.

BACKGROUND: Surgery has previously been the mainstay of treatment for lymphatic malformations but has attendant problems of marked scarring, high chance of recurrence and potential nerve damage. Alternative management for these lesions involves the intralesional injection of OK-432. The present paper reviews OK-432 use in lymphatic malformations in children. METHODS: A retrospective chart review was carried out of children undergoing intralesional OK-432 therapy from the Departments of Paediatric Surgery, Paediatric Otolaryngology and Plastic Surgery at Starship Children's Hospital, Auckland. RESULTS: Over the past 4 years, seven children under the age of 5 years underwent OK-432 therapy as day-case procedures requiring between one and seven procedures each. Four children had lesions involving the axilla/chest wall, two involved extra-mylohyoid tissues in the neck and one child had lymphatic malformation involving tongue, floor of mouth and an extra-mylohyoid component. Spontaneous haemorrhage into a cystic space may be the cause of the observed partial resolution of the lymphangiomas in two. A predictor of a successful outcome was the ability to aspirate fluid prior to injection. Ultrasound guidance was useful to localize the lesions for aspiration and injection. Macrocystic lesions respond well to OK-432 therapy but the response of microcystic or cavernous lesions to OK-432 is disappointing and surgery remains the definitive treatment for these microcystic lesions. CONCLUSION: OK-432 appears to be a safe and effective treatment for the macrocystic component of lymphatic malformations.

Antineoplastic Agents↗