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Biomedical subjects

R G Berkowitz

Publications and source records attributed to R G Berkowitz.

36 records · Page 2Linked to original sources
PubMed1998

Neonatal upper airway assessment by awake flexible laryngoscopy.

Awake flexible laryngoscopy (AFL) provides simple and quick assessment of both the structure and function of the upper airway. To determine its value in neonates, a prospective study was carried out over 2 years of 110 neonates (80 term, 30 premature) under 6 weeks of age (corrected for prematurity) presenting with symptoms suggestive of upper airway disease who underwent AFL performed by the author. A diagnosis was made in 79 cases, while no cause was found for the symptoms in 31. The commonest diagnoses were vocal cord paralysis (29; bilateral 16, unilateral 13), nasal stenosis (9), laryngomalacia (9), glossoptosis (7), subglottic stenosis (6), and choanal atresia (5; bilateral 2, unilateral 3). The AFL was repeated in 31 neonates and the condition was found to be stable in 16, improved in 8, resolved in 2, and progressed in 1, and an additional diagnosis was made in 4. Endoscopy under general anesthesia with or without corrective surgery was performed in 15 neonates (7 also having repeat AFL). The diagnosis was confirmed in 14 and an additional tracheal abnormality was found in 1. The AFL was complicated by cyanosis in 2 neonates and epistaxis in 1, but all complications resolved with minimal intervention. These data suggest that the neonatal upper airway can be relatively safely and reliably assessed by AFL performed by an experienced clinician.

Female↗
PubMed1997

Management of secondary hemorrhage following pediatric adenotonsillectomy.

A retrospective study was performed of all patients requiring admission to the Royal Children's Hospital, Melbourne over a 12 year period with secondary haemorrhage following adenotonsillectomy, to determine what percentage of these children received blood transfusions or were returned to the operating room to secure hemostasis, and to identify factors predictive of the need for major intervention. There were 163 children who presented from 2 to 15 days following surgery. Initial management in all cases was establishment of intravenous access, and 151 received intravenous or oral antibiotics. One hundred and forty one were managed without the need for major intervention (87%), including five who had silver nitrate cautery to the tonsillar fossae. Major intervention was required in 22 cases (13%): 5 patients were returned to the operating room for hemostasis; 15 received blood transfusions and 2 underwent both. All surgery was required within 12 h of admissions and all blood transfusions within 24 h. The highest rates of major intervention were in those with fresh bleeding at the time of presentation (38%) and hemoglobin levels less than 100 g/l (36%). For those requiring admission with secondary haemorrhage, a period of observation of 24 h would probably be adequate in the majority of cases to identify those children who will require major intervention by surgery or transfusion.

Adenoidectomy↗
PubMed1997

Acute mastoiditis in children: a 12-year retrospective study.

We undertook a retrospective study to examine our experience with acute mastoiditis over a 12-year period. Fifty-eight cases were identified in children aged 3 months to 15 years. Acute mastoiditis was the first evidence of otitis media in 54% of our patients. Pain and fever lasting for more than a median period of 4 days were most likely to be the harbingers of incipient acute mastoiditis. Streptococcus pneumoniae was the most common organism recovered from the cultures. All children were treated with intravenous antibiotics; 41 children were managed with an adjunctive drainage procedure. No statistically significant differences were observed between the cure rates and failure rates for children treated surgically with myringotomies with or without tubes and children managed more aggressively with mastoidectomies. One infant had bacterial meningitis. Cholesteatoma was diagnosed in two children. We conclude from our study that acute mastoiditis occurs mainly in young children and may be the first evidence of ear disease. Pain and fever that persist despite appropriate treatment for acute otitis media are the two most important symptoms. Intravenous antibiotics combined with myringotomy with or without tube insertion are as appropriate as intravenous antibiotics with mastoidectomy for initial management of acute mastoiditis in the absence of a subperiosteal abscess or central nervous system extension.

Acute Disease↗
PubMed1997

Respiratory activity of the rat posterior cricoarytenoid muscle.

An anatomic and electrophysiological study of the rat posterior cricoarytenoid (PCA) muscle is described. The intramuscular nerve distribution of the PCA branch of the recurrent laryngeal nerve was demonstrated by a modified Sihler's stain. The nerve to the PCA was found to terminate in superior and inferior branches with a distribution that appeared to be confined to the PCA muscle. Electromyography (EMG) recordings of PCA muscle activity in anesthetized rats were obtained under stereotaxic control together with measurement of phrenic nerve discharge. A total of 151 recordings were made in 7 PCA muscles from 4 rats. Phasic inspiratory activity with a waveform similar to that of phrenic nerve discharge was found in 134 recordings, while a biphasic pattern with both inspiratory and post-inspiratory peaks was recorded from random sites within the PCA muscle on 17 occasions. The PCA EMG activity commenced 24.6 +/- 2.2 milliseconds (p < .0001) before phrenic nerve discharge. The results are in accord with findings of earlier studies that show that PCA muscle activity commences prior to inspiratory airflow and diaphragmatic muscle activity. The data suggest that PCA and diaphragm motoneurons share common or similar medullary pre-motoneurons. The earlier onset of PCA muscle activity may indicate a role for medullary pre-inspiratory neurons in initiating PCA activity.

Animals↗
PubMed1996

Hematoma and abscess of the nasal septum in children.

OBJECTIVE: To evaluate the clinical characteristics and treatment outcome of hematoma and abscess of the nasal septum (HANS) in children. DESIGN: Retrospective case series. SETTING: Pediatric tertiary care facility. PATIENTS: Consecutive series of 20 children (age, 2 months to 15 years; mean age, 7 years) who were admitted to the hospital for treatment of HANS after nasal trauma during an 18-year period. INTERVENTIONS: In addition to receiving antibiotics, all patients underwent general anesthetic for incision and evacuation of the collection of blood and pus together with nasal packing. RESULTS: All patients had a history of nasal trauma. The HANS was a consequence of child abuse (2 patients younger than 2 years), minor nasal trauma (14 patients aged 1 to 10 years), and sports injury (4 patients older than 10 years). The diagnosis was made 1 to 14 days (mean, 5.9 days) after the episode of trauma. Nasal obstruction was the most common symptom found and was present in all but 1 patient. Pain, rhinorrhea, and fever occurred in 50%, 35%, and 25% of patients, respectively. Nasal fracture was present in 3 children. Abscess was found at surgery in 12 patients and was universally associated with septal cartilage destruction. Hematoma was present in 8 patients and associated with cartilage destruction in 2 patients. Organisms cultured were Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococcus and were obtained from all 12 patients with septal abscess and from 1 patient with septal hematoma. Corrective nasal surgery has been performed in 5 patients, 4 of whom had a history of septal abscess. CONCLUSION: The diagnosis of HANS must be considered in all children who have acute onset of nasal obstruction and a history of recent nasal trauma to minimize the risk of nasal deformity and prevent the development of septic complications.

Abscess↗
PubMed1996

Early adenotonsillectomy for relief of acute upper airway obstruction due to acute tonsillitis in children.

Early adenotonsillectomy (TA) for acute upper airway obstruction precipitated by acute tonsillitis was performed in 17 children admitted to the Royal Childrens Hospital over a 15 year period. The age ranged from 13 to 83 months (mean 37 months) and surgery was performed from 1 to 11 days (mean 5.8 days) following admission. One child who underwent surgery within 24 h of admission had an intraoperative blood loss of 250 ml requiring transfusion, but there were no cases of post operative hemorrhage. Airway obstruction was relieved by surgery in all cases and patients were discharged 1 to 6 days (mean 2.4 days) later. Early TA should be considered for relief of upper airway obstruction due to acute tonsillitis after an initial 24 h of intravenous antibiotic therapy.

Acute Disease↗
PubMed1996

Laryngeal electromyography findings in idiopathic congenital bilateral vocal cord paralysis.

Children with idiopathic congenital bilateral vocal cord paralysis (BVCP) were investigated by electromyography (EMG) of the posterior cricoarytenoid and thyroarytenoid muscles to determine whether laryngeal EMG findings had diagnostic or prognostic significance. Four children between 3 weeks and 33 months of age were studied. Three had abductor paralysis and were tracheostomy-dependent, while the fourth had adductor paralysis requiring a feeding gastrostomy. Two of these patients also had other anomalies. Motor unit potentials showing phasic bursts with respiration were found in all four cases, while three children developed a full interference pattern on lightening of the anesthetic. Follow-up for between 37 and 52 months showed no significant clinical improvement in any of the patients. While the diagnosis of idiopathic congenital BVCP can represent a heterogeneous group of conditions, the findings suggest that normal laryngeal EMG findings may be a feature of idiopathic congenital BVCP but do not imply a favorable prognosis for early recovery. They may, however, have implications to explain the likely site of lesion in idiopathic congenital BVCP.

Child, Preschool↗
PubMed1995

Paediatric laryngotracheal reconstruction: Melbourne experience at the Royal Children's Hospital.

A retrospective study was carried out to evaluate the outcome following laryngotracheal reconstruction (LTR) performed in 15 children for the treatment of severe laryngotracheal stenosis between 1989 and 1993. The age ranged from 18 months to 19 years with all but one patient being tracheostomy-dependent. The tracheostomy tube was successfully removed in 12 children who remain free of obstructive symptoms at follow up. One patient was successfully decannulated but required repeat tracheostomy 8 months later for intermittent severe supraglottic/pharyngeal obstruction. There were two failures, with one of these undergoing repeat LTR with successful decannulation. Surgery was complicated in one child by aspiration which improved spontaneously. These findings suggest that LTR is a safe and effective procedure for the management of severe paediatric laryngotracheal stenosis.

Adolescent↗
PubMed1994

Acquired subglottic cysts in infancy.

OBJECTIVE: To evaluate the presentation and treatment of infants with acquired subglottic cysts. DESIGN: Case series seen over 12 years. SETTING: Academic tertiary referral pediatric medical center. PATIENTS: Eleven patients had subglottic cysts diagnosed. INTERVENTION: Four patients were treated with rupture with the tip of the endoscope. Seven patients underwent endoscopic marsupialization by means of carbon dioxide laser (n = 5) and by cup forceps (n = 2). OUTCOME MEASURES: Intraoperative cyst control. Symptomatic cyst recurrence. RESULTS: Initial cyst management was successful in all cases. There was one symptomatic recurrence in a patient who was managed with cyst rupture. There were no symptomatic recurrences in the group treated by marsupialization. The mean follow-up period was 6 years. CONCLUSIONS: Subglottic cysts should be considered in the ex-premature infant with a history of neonatal intubation who presents with stridor or respiratory difficulty. These ductal retention cysts can develop after periods of intubation of less than 24 hours. Endoscopic marsupialization is the recommended form of treatment.

Child, Preschool↗
PubMed1994

Experience with anterior cricoid split for infantile subglottic stenosis.

A retrospective study of infants undergoing anterior cricoid split (ACS) from 1989 to 1993 was performed to evaluate our unit's experience with ACS in the management of infantile subglottic stenosis (SGS). Twelve children were identified ranging in age from 10 to 30 weeks and weighing between 1200 and 6500 g. Nine were born at or less than 30 weeks' gestation. Indications for surgery were endotracheal tube dependency, nasopharyngeal continuous positive airway pressure dependency and recurrent croup. All had varying degrees of SGS. Eleven of the 12 patients were extubated successfully following surgery. Two of these required subsequent repeat ACS 6 and 9 months later with one patient eventually requiring tracheostomy. These results suggest that ACS can be safely employed as an alternative to tracheostomy for a variety of clinical presentations of infantile SGS, with a relatively high rate of successful extubation.

Bronchoscopy↗
PubMed1994

The management of posterior glottic stenosis following endotracheal intubation.

Four patients with bilateral vocal cord fixation due to isolated posterior glottic stenosis that developed following endotracheal intubation are presented. Two patients had previously undergone multiple endoscopic surgical procedures without obtaining a satisfactory airway. All four were treated by posterior cricoid split and costal cartilage interposition and were successfully decannulated. The assessment of vocal cord immobility following endotracheal intubation is presented and the surgical management of posterior glottic stenosis discussed.

Adolescent↗
PubMed1991

Complete evaluation of the child identified as a poor listener.

With increasing awareness among educators of the importance of early identification of hearing impairment, growing numbers of children are being referred for evaluation when a teacher or day care supervisor perceives that a child is having difficulty listening. Some children who manifest difficulty listening in a pre-school play group or the classroom may have conductive or sensorineural hearing loss, while others have normal hearing with an underlying and yet-to-be-detected behavioral or psychoeducational disorder. This report presents suggestions for evaluation of the child referred for difficulty listening. The otologist should consider that a child may have an attention deficit disorder when results of initial audiologic assessment indicate there is no hearing loss or when the degree of hearing loss appears to be small in relation to the degree of inattentiveness that has been observed. The features of Attention-deficit Hyperactivity Disorder (ADHD) and Specific Developmental Disorder (SDD) are described, and illustrative case studies are presented. Clues to diagnosis are provided and a distinction between overlapping disorders is made.

Attention↗
PubMed1990

Tonsillectomy in children under 3 years of age.

A retrospective study was performed on 190 children younger than 3 years who underwent tonsillectomy either alone or in combination with other surgical procedures at the Children's National Medical Center, Washington, DC, over a 5-year period. The average age was 2 years 4 months and average weight was 12.8 kg. The most common indication for surgery was upper airway obstruction with apnea. One hundred sixty-two of 190 patients were discharged on the day following surgery. Complications were seen in 20 (10.5%) patients, 16 requiring prolongation of hospital stay and 4 requiring readmission. However, apart from one child with cerebral palsy who had multiple post-operative complications, no other child required reintubation, blood transfusion, or return to the operating room. It is concluded that age should not be a factor in determining whether or not to proceed with a tonsillectomy.

Apnea↗
PubMed1990

Expansion of the infant subglottis by external cricoid distraction: an animal model.

A technique is described to expand the subglottis by anterior cricoid split (ACS) combined with external cricoid distraction (ECD) using a posterior belly of digastric muscle sling. This technique was used on 5-week-old rats that were killed 6 weeks after surgery, and the larynges were examined histologically and compared with those of rats who underwent ACS alone. Information was available from ten animals in the ECD group and five in the ACS alone group. Separation of the cut ends of the cricoid was found to be maintained in all animals after ECD, the gap having been filled by fibrous tissue lined by respiratory epithelium. A lesser degree of cricoid separation was seen in the animals that underwent ACS alone.

Animals↗