[Severe cervical kyphosis causing sudden inspiratory stridor].

An 85-year-old woman was brought to an accident and emergency department with breathing difficulties accompanied by inspiratory stridor. She was being treated for hypertension and severe osteoporosis which had caused thoracal and cervical fractures of the columna. Intubation was initiated as she desaturated and deteriorated despite maximum oxygen therapy. The intubation revealed a subglottic stenosis as a consequence of a recent osteoporotic fracture in the cervical columna. This represents a rare cause of respiratory failure as all other cardial, pulmonary and allergic aetiologies had been eliminated.

Need for more clear parental recommendations regarding foreign body aspiration in children.

INTRODUCTION: Foreign body (FB) aspiration is a common cause of respiratory emergency in early childhood and is associated with a high rate of airway distress. FB aspiration peaks at the age of 1-2 years. Factors placing children at higher risk include incomplete dentition, immature swallowing coordination and the tendency to be easily distracted while eating. Symptoms may vary from an un-affected child to impending airway failure. Mucosal cough receptors often accommodate and the child may be asymptomatic when evaluated. MATERIAL AND METHODS: Files of children (0-15 years) admitted with suspected FB aspiration were reviewed. Patients were included if the FB was confirmed by bronchoscopy. RESULTS: Among 136 children undergoing bronchoscopy, a FB was confirmed in 59 patients. The median age was one year. All children had a history of aspiration and in 48% a persistent cough was present at the initial examination. Eleven children (19%) had a normal physical examination at admission. Nuts were identified in 34% and carrots in 20%. Of the FBs removed, 86% were organic and 14% were inorganic. Organic FBs were more common in patients younger than three years (p < 0.001). CONCLUSION: Parental suspicion of FB aspiration indicates acute bronchoscopy in children, even in case of no abnormal findings. The completion of the bronchoscopy within 24 hours facilitates the examination and reduces the risk of complications. We recommend increased awareness of the hazards associated with small crunchy organic food items, especially nuts and carrots, given to children under three years of age. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Cervicofacial nontuberculous mycobacterial lymphadenitis in children.

INTRODUCTION: Nontuberculous mycobacteria are ubiquitous organisms readily isolated from natural waters, drinking water systems and soil. They form a continuous challenge to the human immune system which becomes apparent in patients with impaired immunity. However, most infections occur in seemingly healthy children. The clinical presentation consists of a unilateral, non-tender, persistent, cervical lymphadenopathy without systemic illness. Fistula formation may occur. MATERIAL AND METHODS: Patients were included if one or more of the following were positive; 1) mycobacterial culture, 2) acid-fast microscopy, 3) polymerase chain reaction and/or 4) granulomatous inflammation. RESULTS: On the basis of operative management, two distinct groups were established. Group 1 had an excision of all pathological tissue performed and Group 2 was treated with incision and drainage. There was a difference between the two groups in regard to the risk of developing a postoperative fistula. In Group 1, 50% developed a fistula compared with 91% in Group 2 (p = 0.06). CONCLUSION: Surgical treatment is generally advocated as the treatment of choice. Antibiotic treatment is associated with adverse effects and avoidance of surgery does not justify the inferior results related to antibiotics. A watch-and-wait strategy or antibiotic therapy may be considered when surgical excision carries a high risk of facial nerve injury. Although the lymph nodes may persist for months, spontaneous regression may occur and the children remain systemically well. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Tardive endolaryngeal oedema from blunt laryngeal trauma]. / Tardivt larynxødem efter stumpt traume mod halsen.

INTRODUCTION: Mild to moderate blunt laryngeal injuries are frequent. Under the present management regimens patients are hospitalized for 24h observation due to the potential risk of developing endolaryngeal oedema. This group of patients is poorly described in the literature, and the aim of this study was to estimate the incidence of acute and especially tardive endolaryngeal oedema as well as the association between type of injury, symptoms and findings to improve existing evaluation criteria and treatment regimens. MATERIALS AND METHODS: A retrospective analysis of 130 cases exposed to mild to moderate laryngeal injury was performed. The mechanism of injury, symptoms, findings and treatment were registered. RESULTS: Strangulation was the most common type of injury which was seen in 43% of cases, while stranglehold, fall and blow were observed in 29, 14 and 14%, respectively. Dysphagia was reported by 55%, while hoarseness was observed in 17% and stridor in 5%. Fibreoptically, 33% had endolaryngeal pathology. Twenty cases received treatment, 110 were observed. Immediate intubation was performed in 2.3% of the cases. In the observation-group, more patients were exposed to self-inflicted strangulation (p = 0.01). Fall and blow accidents were more frequent in the treatment than in the non-treatment group (p = 0.03). More patients in the treatment group had dyspnoea (p < 0.001), stridor (p = 0.001), hoarseness (p = 0.007) and endolaryngeal pathology (p < 0.001) than in the non-treatment group. CONCLUSIONS: In general, mild to moderate blunt external laryngeal injuries seem rather harmless and should need no further treatment. Nevertheless, any injury against the paediatric larynx and injuries related to fall-accidents or genuine hangings are associated with an increased risk of a respiratory threat. No patients in this study developed tardive laryngeal oedema.