Hugo Rodríguez

Choanal atresia associated with maternal hyperthyroidism treated with methimazole: A case–control study

Thyrotoxicosis affects 0.2% of pregnant women and antithyroid drugs are the treatment of choice during pregnancy. Several case reports have suggested a relationship between the prenatal use of methimazole (MMI) and choanal atresia in the offspring. However, two epidemiological studies did not find an increased teratogenic risk for MMI. This multicenter case–control study compared the frequency of maternal hyperthyroidism treated with MMI during pregnancy, in children with choanal atresia (cases) and a control group randomly selected (three matched controls according to maternal age for each case). Mothers of cases (N = 61) and controls (N = 183) were interviewed for socio‐demographic questions, obstetrical and genetic history, and exposure during pregnancy to different agents; specifically detailed information regarding hyperthyroidism and MMI intake was obtained. Prenatal exposure to maternal hyperthyroidism treated with MMI was identified in 10/61 cases (16.4%) compared to 2/183 (1.1%) in the control group (OR = 17.75; CI95% = 3.49–121.40). Cases and controls did not differ in their parental degree of education, paternal occupation, twinning, maternal parity, and other exposures during pregnancy. Facial features in exposed cases showed some similarities. Our data suggest that prenatal exposure to maternal hyperthyroidism treated with MMI is associated with choanal atresia. In addition, based on our cases and a critical literature review, we propose that the mothers disease might be the causal factor and not the MMI treatment.

Inhaled foreign bodies in children: A global perspective on their epidemiological, clinical, and preventive aspects†

While several articles describe clinical management of Foreign Bodies injuries in the upper air tract, little epidemiological evidence is available from injury databases.

Experiencia de 20 años en el tratamiento microquirúrgico de la atresia de coanas

INTRODUCTION AND OBJECTIVES Choanal atresia is the most common congenital nasal anomaly. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and different surgical techniques and approaches are used. We describe our experience in transnasal microsurgical treatment of congenital choanal atresia. METHODS We retrospectively evaluated 49 patients with congenital choanal atresia operated in the Department of Respiratory Endoscopy over a period of 20 years. The clinical variables analysed were type of atretic plate, age at diagnosis and surgery, associated malformations, maternal history of hyperthyroidism treated with methimazole during pregnancy, mode of airway stabilisation before surgery, surgical technique, complications, and outcome. RESULTS Mixed bilateral choanal atresia was the most frequent (29 cases). Its incidence was higher in females (61.2%). Almost 51% of patients showed associated malformations, and 7 had a history of maternal hyperthyroidism treated with methimazole during pregnancy. The surgical procedure consisted of a transnasal microscopic approach and placement of a silicone endonasal stent for one to 12 weeks. Thirty-five patients required revision after surgery. Nine patients had complications. Suitable nasal ventilation was achieved in 46 patients (93.9%). One patient died of causes unrelated to the surgery. Two patients with permeable choanae remain with tracheotomy. CONCLUSION The transnasal microsurgical repair with endonasal stent proved to be a safe and effective procedure.

Quiste sacular congénito de laringe: una causa rara de estridor en neonatos y lactantes

Stridor is a noise caused by the passage of turbulent air through a diminished airway caliber. Laryngomalacia is the most common congenital anomaly of the larynx and the principal cause of stridor in children under 6 months. A less common etiology of stridor and respiratory distress in newborns and infants is congenital laryngeal saccular cyst. This entity should be considered in the differential diagnosis of stridor. Early recognition and proper treatment are essential because it can cause life-threatening airway obstruction. We describe our experience with 4 patients with this disease, 3 of them successfully treated with microsurgical resection of the cyst, and we emphasize the importance of considering the endoscopic evaluation of the airway in every child exhibiting stridor with an unexpected evolution to determine the causal lesion.

Epidemiology of foreign bodies injuries in Ecuador: a first look based on a single centre experience.

OBJECTIVE The analysis of foreign bodies (FB) injuries in the upper aero-digestive tract is not available for Ecuador and in this context, the present article represent the is the first presenting to the international community the basic epidemiological data on the Ecuadors experience on foreign bodies juries. METHODS Data on 258 cases were gleaned using Susy Safe database, choosing the cases coming from Ecuadors institutions, namely Francisco De Icaza Bustamante Children Hospital, in Guayaquil (Ecuador) which collects data on children injuries due to foreign bodies with the aid of a standardized case report forms. RESULTS Patients showed a female:male ratio of 1:1.2. Fifty-three percent of the children were younger than 2 years of age, with a mean age of 3.22 years. The most frequent location of retrieval was the oesophagus (37.98%) followed by the ears (34.88%). Coins were the most frequent cause of accident (37.21%). Seeds and grain were the most frequent food FBs and they were seen in 13.95% of cases. Adult presence was recorded in 113 cases. There was indeed a significant correlation between the presence of an adult and the activity that the children were doing when the incident occurred. CONCLUSIONS This first breach into the analysis of injuries in Ecuador gives the confirmation that the results coming from countrys data agreed with the general Susy Safe ones. Similar preventive strategies are therefore highly recommended, stressing that primary prevention has the main role in childrens protection.

Nuevo stent laríngeo en el tratamiento de la estenosis subglótica en niños

We present a 3-year-old, preterm, male patient, who suffered bronchopulmonary dysplasia and was tracheostomised, giving rise to Cotton grade III subglottic stenosis (SS) secondary to prolonged intubation, which was subsequently treated by laryngotracheofissure with a posterior cricoid split and interposition of anterior costal cartilage and placement of a new suprastomal stent (Fig. 1). The laryngeal stent employed was created from a number 8 T-shaped tube. After measuring the distance from the anterior commissure to the superior margin of the tracheal stoma, we cut the internal branch to the correct length, separating it from the rest of the T tube. The proximal and distal ends were covered with rounded silicone seals. The stent was placed in a suprastomal position by the laryngofissure and fixed by a double transfixing point at the level of the cricoid cartilage with a support of silicone buttons in the subcutaneous tissue of the neck. The correct position was confirmed by observation through the tracheal stoma and also orally (Fig. 2).

Complicaciones debido a la aspiración de cuerpos extraños en niños

INTRODUCTION AND OBJECTIVES Foreign body aspiration in childhood is a common and potentially serious problem. Complications may be the result of the aspiration episode itself, delayed diagnosis or treatment. We describe our experience in a paediatric hospital in Argentina. METHODS We retrospectively evaluated 56 patients with complications due to foreign body aspiration recorded in the Susy Safe Project between January 2010 and November 2013. The clinical variables analysed were sex, age at time of aspiration, foreign body location and type, time elapsed from the event until object removal, extraction technique, complications, need for hospitalisation and circumstances of the event. RESULTS 58.9% of the cases described occurred in males, with high presence of adults (76.8%) at the time of aspiration. The incidence was slightly higher in children older than 3 years. In 37 cases (66.1%), the foreign body was located in bronchus; sunflower seeds and ballpoint caps were the most common foreign objects. Only in 10 cases (17.9%) was the object extracted within 24h of the event. The most common complications were pneumonia (18 cases), granuloma (15 cases) and mucosal erosion (9 cases). Hospitalisation was necessary for 41 patients. CONCLUSION Early diagnosis and immediate control through specialised teams are essential to ensure proper treatment, usually endoscopic, without risk of complications.

Esofagitis eosinofílica asociada a papilomatosis laríngea en una niña

A female patient, aged 3, presented at the Respiratory Endoscopy Service with progressive dysphonia, which she had had since she was one. She had no difficulty swallowing nor was there any history of atophy. Her physical growth was normal. A fibrolaryngoscopy, followed by a direct laryngoscopy was performed under general anaesthesia which showed papillomatosic formations on both vocal cords and ventricular bands (Fig. 1A). These were resected with cup forceps under microscopic control. Mucosal folds in the hypopharynx area were also observed (Fig. 1B), and an oesophagoscopy was therefore performed which revealed longitudinal furrows with surrounding healthy mucous membrane (Fig. 2A), and whitish granulation tissue in the distal oesophageal mucous membrane. A tissue sample was taken from the upper third, middle and lower third of the oesophagus. Histopathology confirmed laryngeal papillomatosis and showed oesophageal mucous membrane covered by a squamous epithelium with a high number of leukocyte eosinophils (>24 per high-power field), which tended to group together in the outer layers forming microabcesses (Fig. 2B), compatible with eosinophilic oesophagitis.

Septal perforation in children due to button battery lodged in the nose: Case series

Nasal foreign bodies are common in children. Button batteries deserve particular interest due to the severity and precocity of the injuries they cause. The button battery represents a growing danger. Its small size and brilliant appearance make them attractive to children, often being introduced in the nose, ear or mouth. It is imperative that the community and physicians are aware of the risks it poses. Early diagnosis and immediate removal is essential. Their delay can lead to necrosis of the nasal mucosa and septal perforation. We report 10 cases of septal perforation due to button battery. We emphasize the dangers of nasal impaction and the need for quick removal to avoid long-term complications.

Cornaje del recién nacido por estenosis congénita de la apertura piriforme: serie de casos

: Stertor is a noise generated by the disturbance of the air flow passing through the nose. Its main cause -in newborns and infants- is inflammatory or infectious rhinitis. Congenital, neoplastic, traumatic or iatrogenic causes are less frequent. Congenital stenosis of the pyriform aperture is a rare etiology of nasal obstruction in the neonates. Early diagnosis and appropriate treatment are essential because of their exclusive nasal breathing. Suspicion might arise when a difficulty or even an impossibility to pass a probe of 2.8 mm (K30 tube) through anterior nares, exists. Diagnosis should be confirmed by a computed tomography of the craniofacial massif. The therapeutic behavior will depend on the severity of symptoms. We describe our experience with nine patients with this condition whose surgical correction was successful.