Tracheostomy

Article Abstract:

Tracheostomy is a procedure in which a cut is made through the skin to open an airway into a blocked trachea, the tube connecting the nasal passages and mouth to the bronchi and lungs. Although tracheostomy has been performed for 2,000 years, its safety and indications in children have recently been assessed. One hundred and forty-two cases of tracheostomy performed in children over a 10-year period were reviewed to determine the current indications and frequency of resulting disease. The patients were aged one day to 24.8 years when they underwent tracheostomy, and among them were 70 cases in which the procedure was performed in the first year of life. Indications for tracheostomy included injury in 21 cases; acquired subglottic stenosis, or narrowing of a portion of the larynx, in 21 cases; subglottic hemangioma, or a benign tumor of dilated blood vessels in a portion of the larynx, in 16 cases; Guillain-Barre syndrome, the inflammation of many nerves resulting in muscle weakness and paralysis, in 14 cases; Pierre Robin syndrome, characterized by a small jaw, displaced tongue, and lack of a gag reflex, in nine cases; disorders of the skull and face, in nine cases; an abnormally small jaw in five cases; and other conditions in 47 cases. The tracheostomy was maintained for an average of 104 days, and still remains in 25 patients. Eighty-four patients were discharged with a tracheostomy still in place, and tracheostomy did not prevent patients from being discharged by four weeks. Death due to tracheostomy occurred in two patients with severe acquired subglottic stenosis. No deaths due to tracheostomy occurred at home, and complications of the procedure included the development of abnormal growths in 19 cases. Thirteen children developed a fistula, or abnormal passage, after the tracheostomy was removed, and required surgery to close off the fistula. Four other children required repair of a scar caused by the tracheostomy. Thus, tracheostomy is well tolerated by children, causes few complications, and can be safely managed at home. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Children, Pediatric surgery, Trachea

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Growth after gut resection for Crohn's disease

Article Abstract:

Crohn's disease, a chronic inflammation of the small intestine, causes growth retardation in children. It can be treated by surgical resection, or removal, of the diseased bowel. Previous studies have reported conflicting results about whether or not children's growth catches up with developmental norms following surgical treatment. Researchers undertook a record review of 72 children with Crohn's disease, 17 of whom had bowel resections, to determine if significant growth occurred postoperatively. Although 13 of the 17 children were abnormally short pre-operatively, 12 experienced accelerated growth after surgery. Seven of these 12 children had early signs of puberty or were fully pubertal before surgery; all girls in this group started menstruation within one year following bowel resection. The other five children with catch-up growth were prepubertal. These results indicate that children with Crohn's disease have the potential to gain height following bowel resection, even after the beginning of puberty. The children received high calorie diets with good quality protein, probably an important factor in their postoperative growth. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Prognosis, Crohn's disease, Dwarfism

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A 55-year-old man with a long-term tracheostomy and acid-fast bacilli in peristomal granulations

Article Abstract:

A 55-year-old man was admitted to a hospital with difficulty breathing and a history of sleep apnea. He had received a tracheostomy about 14 years prior to admission to treat his sleep apnea. Ten months before admission, the area around the tracheostomy became red and swollen. He failed to respond to antibiotics and corticosteroids. Staining of tissue samples taken from the tracheostomy revealed the bacterium Mycobacterium, which causes tuberculosis. His chest X-ray was negative for TB but he came from Ecuador, where the disease is endemic. He was successfully treated with antibiotics specific for this organism.

Care and treatment, Diagnosis, Sleep apnea syndromes, Sleep apnea, Mycobacterial infections, Mycobacterium infections

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