Mid-term results of vascular ring surgery.

BACKGROUND: Vascular rings cause respiratory symptoms in children. Treatment consists of surgical division; however, data regarding mid-term results are scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. METHODS: Retrospective chart review of consecutive patients who underwent vascular ring surgery. Mid-term follow-up consisted of clinic visits and telephone questionnaire over a 1-year period sampling at five points in time. RESULTS: Follow-up of 85 patients who underwent vascular rings surgery revealed significant symptomatic improvement within 6 months. In total, 50% were symptomatic to some degree at their last documented clinic visit complaining of stridor (36.8%), cough (34.2%), wheezing (10.5%), dyspnoea on exertion (10.5%), or recurrent respiratory infections (23.7%). By telephone questionnaires, 83% described a significant improvement in respiratory symptoms, 63.4% had some residual symptoms, 36.6% stridor, 38.8% chronic cough, 32.4% bronchodilator use,18.3% had at least one episode of pneumonia per year, 31% of children had dyspnoea or respiratory limitation, and 12.7% while doing physical activities. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. CONCLUSIONS: Surgical division of vascular rings results in significant clinical improvement within 1 year; nevertheless, some patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. Further evaluation is warranted to assess the nature of residual symptoms and explore whether anatomical causes can be identified leading to surgical modifications.

Severe hypersensitivity reactions to corticosteroids in children.

OBJECTIVE: To present 3 children with hypersensitivity reaction to methylprednisolone sodium-succinate and review the literature regarding such reactions. METHODS: Data on the clinical features were obtained from the children's files. Skin prick tests were performed with a panel of corticosteroid preparations. RESULTS: Three patients (5, 7, and 8 years) with asthma who were treated with intravenous methylprednisolone succinate at the emergency department developed hypersensitivity reactions initially consider to be due to their primary disease. Two had a positive skin prick test to methylprednisolone sodium succinate but not to other corticosteroids or to the succinate ester. Skin prick tests to different corticosteroids, performed 4 years after the event in the third patient, were negative. CONCLUSIONS: Methylprednisolone sodium-succinate may cause anaphylactic/anaphylactoid reactions in children. Our patients' histories emphasize the importance of awareness to corticosteroid-induced reactions, especially in children with asthma in whom the symptoms may be considered as an exacerbation of their primary illness.