Preliminary assessment of portable sleep monitoring for diagnosis of obstructive sleep apnea in children.

OBJECTIVE: By observing the differences in sleep parameters between portable sleep monitoring (PM) and polysomnography (PSG) in children, we aimed to investigate the diagnostic value and feasibility of PM in children with suspected obstructive sleep apnea (OSA). STUDY DESIGN: This prospective study enrolled consecutive children (aged 3-14 years) with suspected OSA in Shenzhen Children's Hospital. They had PSG and PM in the sleep laboratory. Clinical parameters of the two sleep monitoring methods were compared. RESULTS: A total of 58 children participated. They were classified into two groups according to age: 28 children aged 3 to 5 years and 30 children aged 6 to 14 years. No significant differences were observed in apnea-hypopnea index (AHI), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) between PM and PSG, but the sleep efficiency with PM was significantly higher (3-5 years age: 92.2 ± 11.3% vs 85.2 ± 14.3%, 6-14 years age: 93.2 ± 14.5% vs 84.8 ± 16.3%, both P < 0.05) than the sleep efficiency with PSG. Pearson correlation analysis indicated a strong correlation between AHI, LSaO2, MSaO2, and sleep efficiency measured by PSG and PM. Receiver operating characteristic curve (ROC) analysis showed that PM was a reliable diagnostic tool for OSA. PM has high sensitivity (3-5 years age: 95.8%, 6-14 years age: 96.3%) and low specificity (3-5 years age: 25.0%, 6-14 years age: 33.3%) for OSA in children. Thus, there is a low rate of missed diagnoses, but there is some inaccuracy in excluding children who do not have OSA. CONCLUSION: The results showed that PM has a good correlation with the various parameters of PSG. PM may be a reliable tool for diagnosing moderate and severe OSA in children, especially those who cannot cooperate with PSG or who have limited access to PSG.

Second branchial cleft cyst with snoring during sleep as initial symptom: A case report and literature review.

ABSTRACT: The second branchial cleft cyst lacks typical symptoms, and its clinical manifestations are complex and varied. Among them, the second branchial cleft cyst manifested by sleep snoring is relatively rare, and it can easily lead to missed diagnosis or misdiagnosis. This paper reports a case of a second branchial cleft abscess with snoring as the main manifestation. The branchial cleft cyst was removed using an endoscopic branchial cleft.

A first-aid fast track channel for rescuing critically ill children with airway foreign bodies: our clinical experience.

OBJECTIVE: To explore the role of a first-aid fast track channel in rescuing children with airway foreign bodies and to analyse and summarize the experience and lessons of the first-aid fast track channel in rescuing airway foreign bodies from patients in critical condition. METHODS: We retrospectively reviewed the medical records of children with airway foreign bodies rescued by first-aid fast track channels admitted to our hospital from January 2017 to December 2020. The corresponding clinical features, treatments, and prognoses were summarized. RESULTS: Clinical data from 21 cases of first-aid fast track channel patients were retrospectively collected, including 12 males and 9 females aged 9-18 months. Cough was the most frequently exhibited symptom (100.0%), followed by III inspiratory dyspnoea (71.4%). Regarding the location of foreign bodies, 5 cases (23.8%) had glottic foreign bodies, 10 cases (47.6%) had tracheal foreign bodies, and 6 cases (28.6%) had bilateral bronchial foreign bodies. The most common type of FB was organic. FB removal was performed by rigid bronchoscopy in every case, and there were no complications of laryngeal oedema, subcutaneous emphysema, or pneumothorax. No tracheotomy was performed in any of the children. CONCLUSION: The first-aid fast track channel for airway foreign bodies saves a valuable time for rescue, highlights the purpose of rescue, improves the success rate of rescue and the quality of life of children, and is of great value for the treatment of critical tracheal foreign bodies. It is necessary to regularly summarize the experience of the first-aid fast track channel of airway foreign bodies and further optimize the setting of the first-aid fast track channel.

Superabsorbent polymer balls as foreign bodies in the nasal cavities of children: our clinical experience.

OBJECTIVE: To summarize the clinical diagnosis and treatment of superabsorbent polymer balls as nasal foreign bodies in children. METHODS: We retrospectively analysed the clinical data concerning 12 cases of superabsorbent polymer balls as nasal foreign bodies in children and summarized the corresponding clinical features, methods of diagnoses and treatment, and prognoses. RESULTS: Twelve children with superabsorbent polymer balls as foreign bodies in their nasal cavities presented with relatively severe symptoms, such as congestion, runny nose, and nasal swelling. When such foreign bodies stay in the nasal cavity for a prolonged period, patients may suffer from general discomfort, such as agitation, poor appetite and high fever. Most of the children had to undergo nasal endoscopy under general anaesthesia to have the foreign bodies completely removed. An intraoperative examination revealed significant mucosal injury within the nasal cavity. With regular follow-up visits and adequate interventions, all the patients recovered. CONCLUSION: The longer superabsorbent polymer balls remain in the nasal cavity, the more damaged the nasal mucosa will be. It is challenging to remove such foreign bodies in the outpatient setting. Transnasal endoscopy under general anaesthesia appears to be safer and more effective in such cases. Since the nasal mucosa is injured to varying degrees, postoperative follow-up and treatment are equally important for preventing the occurrence of complications.

Congenital pyriform sinus fistula presenting as a neck abscess in a newborn: A case report.

RATIONALE: Congenital pyriform sinus fistula (CPSF) is a branchial abnormality originating from the third or fourth branchial pouch and is an important cause of anterior cervical abscess in children. Here we present a case of neck abscess in a newborn that was diagnosed as CPSF. PATIENT CONCERNS: A male infant with a birth weight of 3660 g was admitted to hospital 25 minutes after birth after discovery of a cystic mass with extensive skin swelling in the left side of the neck. B-mode ultrasonography of the left neck showed an anterior cervical cystic mass of indeterminate nature. DIAGNOSIS: Congenital pyriform sinus fistula. INTERVENTIONS: The neck abscess was incised and drained under general anesthesia. Examination under suspension laryngoscopy revealed a pyriform sinus fistula. Laser cauterization was performed simultaneously. The wound was dressed and anti-inflammatory treatment was provided. OUTCOMES: The neck wound healed uneventfully. After 3 months, the fistula was confirmed to be closed by laryngoscopy under general anesthesia. No recurrence was detected during 9 months of follow-up. LESSONS: CPSF should be strongly suspected in a patient with an unexplained neck abscess or recurrent acute suppurative thyroiditis, especially on the left side.

Pharyngeal hairy polyps: Case series and literature review.

It was aimed to report 5 cases of pharyngeal hairy polyps, and to summarize the characteristics combined with literature review.Five cases with pathological diagnosis of pharyngeal hair polyps were diagnosed and treated in our department from June, 2006 to October, 2016, and retrospective analysis of their clinical data was performed. Among the 5 cases, there were 1 male and 4 female, with the age of 2 days to 26 months old. After birth, these patients were accompanied by stridor, difficulty breathing, snoring, feeding difficulties, and slow weight gain.Gray mass in the stem original from the pharynx was found in all 5 cases, with the surface hair-covering. The polyp resections were performed under general anesthesia, with the complete removal of polyp along the pars basilaris during surgery smoothly. The operation during was 5 to 20 minute, with an average of 12 minute, and there was little hemorrhage during operation. Symptoms disappeared completely after the surgery, and follow-up was performed for 1 year without recurrence shown.Pharyngeal hairy polyp is a rare non-malignant clinical disease, mainly caused by symptoms in respiratory tract obstruction. Complete removal of polyps along the pars basilaris is an effective treatment, with no recurrence case reported after surgery.

[Analysis of the causes of immediate bleeding after pediatric adenoidectomy].

OBJECTIVE: To evaluate the incidence of postoperative hemorrhage in children undergoing adenoidectomy, and to discuss its possible causes. METHODS: Included in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Children's Hospital between January 2004 and November 2009. The change of hemoglobin (Hb) and hematocrit (Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct. RESULTS: There were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0.5 - 4.0 hours after surgery, without superfluous hemorrhage during the operation and post-tonsillectomy. This represented an incidence of 0.48%of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, χ² = 5.597, P < 0.05). The change of Hb and Hct was positively correlated (r = 0.95, P < 0.01), the blood loss was positively correlated with the bleeding time (r = 0.66, P < 0.05). The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied. CONCLUSIONS: Poor operative technique and deficient hemostasis are the major causes of primary hemorrhage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.

[Etiology of inspiratory laryngeal stridor in children].

OBJECTIVE: Retrospective analysis was performed on the etiology of inspiratory laryngeal stridor in children. The purpose is to raise the diagnosis and cure rate of the disease. METHODS: All patients were hospitalized in Children's Hospital from Jan, 2005 to Jan, 2007. Among of them, 245 cases were male and 133 cases were female. The median age was 4 months (range from 12 hours to 30 months). All the patients had chest X-ray examination. Two hundred and eighteen cases received chest CT scan, video laryngoscope, direct laryngoscope and bronchofibroscopy. RESULTS: The diagnosis were as follows: acute laryngitis (140 cases), laryngomalacia (117 cases), acute laryngotracheal bronchitis (54 cases), vocal cord paralysis (18 cases), congenital tracheomalacia (9 cases), congenital laryngeal webs (8 cases), congenital cleft of larynx (6 cases), laryngeal cyst (6 cases), laryngeal papilloma (6 cases), acute epiglottitis (4 cases), congenital infraglottic stenosis (3 cases), tracheobronchial foreign body (3 cases), cysts thyrolinguals (1 case). All cases were cured except congenital tracheomalacia (9 cases), congenital cleft of larynx (6 cases), laryngeal papilloma (6 cases), congenital infraglottic (3 cases). CONCLUSIONS: The etiology of inspiratory laryngeal stridor in children are very complicated. Video laryngoscope is recommended for all cases except for the acute inflammation disease. Chest CT scan and bronchofibroscopy may be necessary for some cases.

[Relationship between adenoids hypertrophy and tympanogram/eustachian tube function in children].

OBJECTIVE: To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram/eustachian tube function in children. METHOD: A prospective clinical study from February 2004 to October 2004 was carried out. A total of 120 children with adenoids hypertrophy and 20 normal children were examined. The relationship between AN ratio and middle-ear pressure was evaluated, the eustachian tube function was compared between the children with adenoids hypertrophy and the normal. RESULT: (1) Middle ear pressures were negative related to the AN ratio (r = -0.41, P < 0.05); (2) the eustachian tube function of the children with adenoids hypertrophy was worse than the normal; (3) the relation between the eustachian tube function and the AN ratio was not statistical difference. CONCLUSION: Eustachian tube dysfunction caused by adenoids hypertrophy is the etiologic factor of secretory otitis media.

[Investigation and analysis of quality of life for patients after laryngectomy].

OBJECTIVE: To institute and test the quality of life for laryngectomy, and evaluate the feasibility of above questionnaire in patients after laryngectomy. METHODS: A questionnaire of quality of life for laryngectomy was instituted. An investigation was conducted in patients treated by partial (36, Group A) or total (45, Group B) laryngectomy for laryngeal cancer with above questionnaire. The feasibility, reliability and validity of the questionnaire was evaluated, the quality of life and the influencing factors in laryngectomy were also analyzed. RESULTS: The questionnaire of quality of life for laryngectomy consists of 22 items, covering six aspects. The questionnaire has a comparatively good reliability, and the criterion-related validity and content validity of the questionnaire is valid. The correlation coefficient of split-half method and Cronback's alpha of questionnaire were 0.842 and 0.889 respectively. The composite quality of life scores of group A were significant higher than those of group B ( P < 0.001). The differences in physical function, laryngeal function, psychological state, the ability of living independently were statistically significant (P < 0.001; P < 0.001; P < 0.01; P < 0.05) as well. Seven factors including operative modality, tumor stage, postoperative complication, coexisted disease, family incomes, voicing modality and wearing tracheo-cannula were related to postlaryngectomy quality of life. CONCLUSIONS: The questionnaire of quality of life for laryngectomy has speciality in laryngectomy and a comparatively good reliability and validity, and it is suitable for quality of life research in patients after laryngectomy.

[Inhibition of hydroxycamptothecin on laryngeal squamous carcinoma cell line].

BACKGROUND & OBJECTIVE: Hydroxycamptothecin(HCPT) has wide antitumor spectrum and high inhibition rate of tumor cell line and xenografts. Recently,no studies on the treatment of laryngeal squamous carcinoma with HCPT were reported. Hence,this study were designed to investigate the inhibition of O-HCPT [ring-opened form(O-HCPT)] and C-HCPT[ring-closed form(C-HCPT)] on laryngeal squamous carcinoma cell line(Hep-2 cell line)and its mechanism. METHODS: The cytotoxicity of O-HCPT and C-HCPT on Hep-2 cells was measured by MTT assay and cell cycle was detected using flow cytometry (FCM). The growth state of Hep-2 cell xenografts treated with 10 mg/kg HCPT (O-HCPT or C-HCPT) was observed. The doubling time and the tumor inhibition rate were calculated. RESULTS: The growth inhibition of O-HCPT and C-HCPT on Hep-2 cell depended on concentration. The IC(50) were 0.69 and 0.48 micromol/L, respectively. After treated with high concentration of HCPT, the cell cycle was arrested in S phase and then apoptosis were obviously induced. At the low concentration of HCPT, the cell cycle was slightly arrested in G(2)+M phase. Compared with control group, the xenografts of O-HCPT (10 mg/kg) treated group grew slowly and tumor doubling time prolonged. There was significant difference in the tumor volumes of two HCPT-treated group (P< 0.001) and the tumor inhibition rate was 77.0%. All mice in C-HCPT (10 mg/kg) treated group died of toxicity. CONCLUSION: The result showed that O-HCPT and C-HCPT had obvious cytotoxicity to laryngeal squamous carcinoma cells which mechanism was HCPT arrest cell cycle in S phase and induce cell apoptosis. O-HCPT has slight toxicity effect and can be used as chemotherapeutic agent for laryngeal squamous carcinoma, but C-HCPT had strong toxicity.