Difficulties in diagnosis of laryngeal cysts in children.

INTRODUCTION: In larynx cysts may be localized in different regions: glottis, laryngeal pouch, epiglottis, aryepiglottic folds and subglottic area. It is difficult to estimate if the cyst is acquired or congenital. Symptoms of laryngeal cyst depend on the size and localization of the cyst and include: change in the tone of voice, dysphonia, hoarseness, dysphagia, laryngeal stridor and dyspnoea. Cysts of the larynx in infants are rare but the treatment is easy once the diagnosis is made. If mismanaged, the resulting respiratory obstruction can lead to serious complications. OBJECTIVE: Analysis of cases of laryngeal cyst in children treated in the Department of Paediatric ENT Medical University of Warsaw. MATERIALS AND METHODS: A retrospective analysis of 10 cases of laryngeal cyst in children treated in the Department of Paediatric ENT in Warsaw between 2000 and 2008 was made. RESULTS: The authors analyzed indications to directoscopy, endoscopic presentation, problems with establishing the right diagnosis and management. CONCLUSIONS: Using a direct laryngoscopy as a golden standard in children with stridor will reduce a number of false diagnosis.

Perioperative problems and treatment of a teenager with a juvenile angiofibroma refusing blood transfusion.

OBJECTIVES: Juvenile angiofibroma is a benign, non-encapsulated neoplasm, consisting of vascular and connective tissue. Its main feature is a local malignancy. In its clinical course it destroys adjoining structures, without metastasizing. It appears rarely, and is mainly found in boys at puberty. Among theories about the aetiology of juvenile angiofibroma, we must consider a haematoma-like lesion, an angioma with an extended fibrous component, or type of inflammatory allergic polyp. In the development of the lesion the participation of hormonal disorders on the pituitary gland-gonad axis is also suggested. According to the latest research, juvenile angiofibroma is regarded as a developmental defect, affecting the embryonic vascular network surrounding the sphenoid bone. METHODS: If the patient or his/her parents refuse blood transfusion and use of blood products, it is necessary to apply modifications in the routine perioperative treatment. In the case of the patient refusing blood and blood products transfusion because of their beliefs, it is possible to get consent to use different, highly processed products like albumins or a cryoprecipitate, as well as applying some blood-saving techniques. CONCLUSIONS: 1. Removal of juvenile angiofibroma with minimal bleeding is possible. 2. Applying erythropoietin and iron preparations prior to surgery increases erythropoiesis and reduces the risks in transfusion. 3. Applying intraoperative normovolaemic haemodilution is a safe method and allows avoidance of transfusion of blood-derived products.

The history of pediatric otorhinolaryngology in Poland.

The past few decades have been a time of rapid and constantly-accelerating development in every field of medicine, including pediatrics and laryngology. The first pediatric laryngology unit set up in Poland was in the Warsaw Kopernik Hospital in 1908, and consisted of seven beds in the surgical ward. The actual development of the specialty in Poland began in the nineteen-forties. The first modern department of Pediatric Laryngology was set up in the Mother and Child Institut in 1947, and next in Warsaw University Hospital in 1956. These two were both set up and headed by Associate Professor Jan Danielewicz who is considered to be the father of pediatric otolaryngology in Poland, and one of its co-founders in Europe. The first conference of Polish Pediatric ENT was the result of the efforts of Associate Professor Danielewicz in Zakopane, in 1958. Professors Kossowska and Danielewicz were the joint organisers of the First European Congress of Pediatric Laryngologists in Warsaw, in 1979. At present in Poland exist five Clinic of Pedatric ENT and about 25 ward of this speciality. Pediatric ENT is independent medical specialization.

[Tumours of the bony face in children the treated at the Paediatric ENT Clinic in Warsaw]. / Guzy twarzoczaszki u dzieci leczonych w Klinice Otolarynologii Dzieciecej w Warszawie.

INTRODUCTION: The tumours of bony face at in children are rare. Among the most commonly found are inflammatory tumours and development anomalies. In histopathology, the most frequent fund are neuroma, fibromas, osteoma, lipomas. In inflammatory tumours there are abscess and inflammatory infiltration. Malignants tumours in this area are rare in children, but are mainly sarcomata or melanoma. Developmental tumours include cyst and fistula. OBJECTIVE: To analyse tumours of the bony face treated in Paediatric ENT Clinic in Warsaw. MATERIAL: There were thirty cases of bony face tumours treated in Paediatric ENT Clinic in Warsaw between 2005 and 2007. RESULTS: One cases (3%) provedto be malignant, and one (3%) locally malignant. Twenty-one cases (70%) were found to be developmental tumours, three cases (10%) of abscesses, and four cases (13%) of benign tumours. CONCLUSIONS: The most frequently-found tumours of bony face in children are developmental tumours. All tumours must be the subject of histopatological examination. In the case of cancers tumours it has to be established if the tumour is a primary or a metastatic. In the group analysed group the rare tumour were epithelioma, ganglioma.

Ear tuberculosis: clinical and surgical treatment.

Two main points are discussed in this paper: First, the changing picture of the clinical process of tuberculosis, and second, various diagnostic problems caused by extra-pulmonary forms. We have analysed a case of ear tuberculosis in a child, and drawn the following conclusions: Directed chemotherapy is the primary method of treatment, and surgical methods should be used to provide tissue for bacteriological and histopathological analysis, to enable an early diagnosis during the first stage of the disease, and in other atypical cases.

[Surgical treatment of breathing troubles in children's upper respiratory tract]. / Operacyjne leczenie zaburzen droinosci nosa u dzieci.

The reaction of child's organism to harmful factors is different than that of an adult. The child's organism has greater possibility of regeneration and is still developing. All this should be considered when planning conservative and especially surgical therapy for a patient of formative age. This paper describes in detail surgical therapy of the nases, especially possible reconstruction of the ala nasi, which in this case is of particular importance. It presents modern principles of the surgery of septum deformation and bone pyramids deformation in the nose. The possibility was demonstrated concerning the reconstruction of cartilage deficit in the nasal septum with specials regard for the growth of middle face. Also described are the present day methods of surgery of choane imperforation. Particular attention was devoted to advantages and disadvantages of the surgery through the nasal cavity or through pallatum. The rules have been described concerning preoperative activities as well as preliminary diagnostics and successive stages of surgery specific to patient in the formative years is most frequent diagnosis of congenital anomalies. The children's most frequent congenital anomalies have been discussed and (in the author's opinion) the best way of the operative treatment has been suggested. On the basis of literature and author's own experience endoscopic surgery of the nose and paranasal sinuses have been presented along with preoperative diagnostic, indications for the surgery, and suitable methods as well as against possible complications.

Percutaneous tracheotomy in children.

We present three cases of the Fantoni percutaneous translaryngeal tracheostomy (TLT) performed under direct rigid bronchoscopy. The surgeries were performed in the near-drowned 5-year-old boy, and 15-year-old lupus erythematosus girl with a permanent brain damage resulted from a cardiac arrest, 11-year-old cardiac girl with postintubation laryngeal stenosis. In the first two cases, the procedure went uneventful; in one case the tube was accidentally pulled out during the rotation phase and surgical tracheostomy was performed. We describe the TLT procedure in details, calling special attention at the fact that the TLT is especially suitable for children below 10 years of age and is associated with very few complications.

Lower airway papillomatosis in children.

Laryngeal papilloma in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. This disease has a tendency to recur and the changes are histologically benign. In some cases papilloma may affect the lower levels of the respiratory tract. In this study, among 90 patients treated for laryngeal papillomatosis, in four children papilloma of trachea, bronchi and lung tissue were detected in endoscopic and radiological examination. This constitutes 4.4% of all patients. Compact nodules and acquired cysts between 5 and 50 mm long were found in chest X-rays and in computerised tomography. These cysts appeared from 4 to 8 years after establishing a diagnosis of laryngeal papilloma, and 1 year after recognising papilloma in the trachea. In all four children the presence of nodules and cysts in the lungs was preceded by recurrent pneumonia, emphysema or atelectasis of the lungs. All children with laryngeal papillomatosis should have a chest X-ray. Detection of acquired cyst-like changes in lung tissue in children with laryngeal papillomatosis is a warning of future papilloma in the trachea and bronchi, with involvement of lung tissue. In differential diagnosis of these changes in the lungs we should take into consideration the presence of papilloma in the bronchi. A prognosis of papillomatosis in the lower airways in children is always serious.

The endoscopic treatment of postintubation laryngeal stenosis in children, using argon plasma coagulation.

Laryngeal stenosis of the larynx in children is becoming a more frequent problem. Endoscopic dilation of the lumen of the larynx is one of the many methods of treatment. The authors present their own method for the treatment of postintubation laryngeal stenosis by argon plasma coagulation (APC). The investigation was based on ten children with postintubation laryngeal stenosis from I to IV degrees according to the Myer-Cotton grading system. The method of treatment, and the advantages and disadvantages of the new method of endoscopic treatment of postintubation laryngeal stenosis, are discussed in the article.

Dysfunction of peripheral blood granulocyte oxidative metabolism in children with recurrent upper respiratory tract infections.

Granulocytes play a key role in the defence against bacterial infections. Their dysfunction may both predispose to and result from infections. The oxidative metabolism of peripheral blood granulocytes was studied in 50 children aged from 1 to 10 years, with recurrent upper respiratory tract infections and/or tonsillar hypertrophy. Four groups of patients were recruited: 15 healthy controls, seven patients with idiopathic tonsillar hypertrophy, 12 patients with upper respiratory tract infections and 16 patients with upper respiratory tract infections with concurrent tonsillar hypertrophy. The ability of granulocytes to produce reactive oxygen species was assessed by nFMLP-induced chemiluminescence. Both increased and depressed granulocyte activity was observed in all studied groups, with the exception of controls. Altered granulocyte function was observed in 30% of patients in the idiopathic tonsillar hypertrophy group. In children with recurrent infections abnormal chemiluminescence results were found in from 75% to nearly 90% of patients. This preliminary study demonstrates the possible relationship between recurrent upper respiratory tract infections, tonsillar hypertrophy and impaired peripheral blood granulocyte chemiluminescence.

A comparative study of cefaclor vs amoxicillin/clavulanate in pediatric pharyngotonsillitis.

BACKGROUND: Pharyngotonsillitis (PT) caused by group A beta hemolytic streptococci (GABHS) is one of the most common infections of childhood. Two antibiotic suspensions, cefaclor (CEF) and amoxicillin/clavulanate (AMC), are commonly used in Poland for the treatment of PT caused by GABHS in children. MATERIAL/METHODS: This multi-center, randomized, single-blinded study was undertaken in order to compare the efficacy and safety of CEF (20 mg/kg/d) and AMC (25 mg/kg/d) in 10 days treatment of GABHS-related PT. 100 children (mean age 6 years) were enrolled into the study. Clinical and bacteriological assessments were done on the 14-18 th, and 38-45 th days after randomization. RESULTS: No GABHS strain isolated from throat smears was resistant in vitro to both antibiotics. Both antibiotics had almost 98% effectiveness at the post therapy visit. On follow-up, significantly more relapses and recurrences were observed in the AMC-treated group than in the CEF-treated group (relapse rate 21.28% vs 15.56%, p<0.02, recurrence 10.64% vs 6.66%, p<0.002). The relapse odds ratio in the AMC group was 1.7 times greater than in the CEF group, and recurrence was 1.5 times higher. There were significantly higher rates of gastrointestinal adverse events in children treated by AMC (p<0.02). CONCLUSIONS: CEF provides a clinically and bacteriologically effective treatment for children with PT caused by GABHS, comparable to AMC but significantly safer in terms of gastrointestinal side effects. AMC shows a greater risk of relapse and recurrence than CEF.