This is a prospective study done on six cases of laryngotracheal stenosis. They were operated by laryngoplasty with muco perichondrial grafting stenting (temporary and permanent).The purpose of the study was to determine the role of laryngoplasty in the treatment of acquired subglottic stenosis.In this study, six patients who presented to the Government General Hospital from March 2011 to April 2012, with subglottic stenosis were enrolled. The details of their etiology, time period with endotracheal intubation, duration between extubation and onset of symptoms, treatment and postoperative recovery on followup were recorded and analyzed. It was found that laryngoplasty with cartilage grafting along with Ttube or Dumonts silicone stent placement carries good success rate, with no recurrence.
Objectives To create awareness amongst the medical faculty about a forgotten fatal disease (diphtheria). To determine the age distribution, immunization status, presenting features, prognosis with respect to duration after which they took medication and effect of ADS on recovery in cases of faucial and laryngeal diphtheria. To stress on the importance of DTP immunization to control diphtheria. Study method In this study, 15 patients who presented to the Government general hospital between July and September 2013 with membranous tonsillitis were enrolled. In every diphtheriaproven case, we administrated antidiphtheric serum (ADS) as early as possible along with injection crystalline penicillin (CP) and oral erythromycin. Tracheostomy was done in two cases who presented with stridor. Patient variables and their correlation with recovery were studied. Results Out of 15 cases of membranous tonsillitis, nine tested positive for diphtheria; eight, smear positive and one, culture positive. Of these nine cases, eight were between 9 and 13 years old and one was a 50-year-old man. While tracing immunization status, it was found that three children (33%) were not immunized, four children (22%) had not taken booster doses, and in one child and the adult, immunization history was unknown. Clinical presentation of two of the unimmunized cases was late (on 8th day of fever), with stridor due to laryngeal diphtheria. The third child presented with bull neck, and developed myocarditis. These three cases proved fatal. Six cases which presented early and were managed in time recovered fully. Conclusion Unimmunized children as well as adults are susceptible to diphtheria. High immunization coverage is the only tool to control this infection. Booster doses are needed to control disease in adults. It was found that early diagnosis with high index of suspicion and early administration of ADS along with good supportive therapy carried good prognosis. Every otolaryngologist, pediatrician as well as general practitioner should be ready to manage the cases of diphtheria. Government should be prepared to manage and control epidemics effectively. How to cite this article Murthy GSN, Bhimeswar R, Kumar MV, Prasad PK. Resurgence of Diphtheria: Are We ready to treat? Int J Phonosurg Laryngol 2013;3(2):42-45.
Background: Several inflammatory markers have failed to meet the requirements for an early diagnosis of sepsis in children. Study results and trends show that measurement of the combination of biochemical markers offers the best prospects for research on early diagnosis of sepsis. Objectives: To evaluate the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) as markers of early sepsis in pediatric patients. Methods: All the hospitalized children aged more than 28 days with clinically suspected sepsis, as per the definition given by International Pediatric Sepsis Consensus Conference, were selected. The patients were divided into two groups; one with culture proven sepsis and the other with culture negative sepsis. CRP and PCT levels were measured at the time of admission and 48 h after admission. Results: A 40 patients were studied, out of that 15 had culture positive and 25 had culture negative sepsis. The mean PCT level was significantly higher at admission than at 48 h after admission, and the mean CRP level was significantly lower at admission than at 48 h after admission indicating PCT as early marker of sepsis. Conclusion: CRP and PCT levels have favorable test performance in differentiating between culture positive and culture negative sepsis. PCT is earlier to rise compared to CRP and PCT is best in predicting the severity followed by CRP.
S tridor is the noise from a narrowed airway. It is a sign from which the underlying cause must be sought and is not a diagnosis or a disease [1]. The role of pediatrician in a child with noisy breathing is to determine the etiology, level of obstruction and its severity causing respiratory compromise. The word stridor is derived from the Latin word Stridulus which means creaking, whistling, or grating. Stridor is an abnormal, harsh, and high-pitched inspiratory sound produced by turbulent airflow through a partially obstructed airway of the laryngeal area or the extra-thoracic trachea [2]. Stridor is a predominant inspiratory monophonic noise [2]. It should be differentiated from wheeze later which occurs in forced expiration whereas stridor occurs mostly in inspiration [2]. Wheeze originates from the intrathoracic trachea and alveoli whereas stridor originates from extra thoracic trachea [2]. Upper airway obstruction is a common and serious problem and also a common cause of respiratory failure in infants and children. Stridor is the fairly common symptom of the upper airway obstruction in neonates and children. Medical history and physical examination are the main stay in patients with stridor presenting to the emergency department [3]. The red flag signs of stridor are presence of drooling of saliva and agitation, tripod position, cyanosis, decreased conscious level, respiratory distress, silent chest, bradycardia, and episodes of apnea [2]. The presence of these warning signs should alert pediatricians of the probability of severe respiratory compromise in the child. This warrants immediate management to secure airway to prevent further deterioration of the child. The presence or absence of fever is used to identify infectious and non-infectious causes of stridor. The present study was conducted to determine the most common causes of stridor, according to the age group for better management and outcome. MATERIALS AND METHODS The study was conducted in the department of medicine at a tertiary hospital of south India. Children between 0 and 5 years of age with stridor who presented to pediatric department requiring admission between January 2017 and 2018 were included in study. The study was observational and prospective study. Postextubating stridor patients, children with external trauma to neck, and children with alleged history of acid consumption were excluded from the study. Sample size was estimated based on published literature, 76% cases presented with acute symptoms among 50 cases ABSTRACT Background: Stridor is a harsh, vibratory sound produced when airway becomes partially obstructed, resulting in turbulent flow of air through large airways. Objectives: The objectives of the study were to find out the most common causes of stridor, according to the age group for the better management and outcome. Materials and Methods: The present study was a hospital-based observational study where in children between the age group of 0 and 5 years with stridor were studied over 1-year period at a tertiary hospita...
The study was conducted in the department of medicine at a tertiary hospital of south India. Children between 0 and 5 years of age with stridor who presented to pediatric department requiring admission between January 2017 and 2018 were included in study. The study was observational and prospective study. Postextubating stridor patients, children with external trauma to neck, and children with alleged history of acid consumption were excluded from the study.Sample size was estimated based on published literature, 76% cases presented with acute symptoms among 50 cases ABSTRACT Background: Stridor is a harsh, vibratory sound produced when airway becomes partially obstructed, resulting in turbulent flow of air through large airways. Objectives: The objectives of the study were to find out the most common causes of stridor, according to the age group for the better management and outcome. Materials and Methods: The present study was a hospital-based observational study where in children between the age group of 0 and 5 years with stridor were studied over 1-year period at a tertiary hospital of south India from January 2017 to 2018. A total of 71 cases were included in the study. Children were subjected to chest X-ray, computed tomography scan, blood tests, laryngoscopy, and bronchoscopy according to requirement and findings complied and analyzed statistically. Results: Majority of the stridor cases were in the age group of <1 year, male outnumbered females. The etiologies of stridor in present study were croup (47.9%), laryngomalacia (19.7%), laryngeal diphtheria (12.7%), subglottic stenosis (7.04%), laryngotracheomalacia (2.8%), glottic web (1.41%), left vocal cord paresis with subglottic stenosis with tracheomalacia (1.41%), subglottic stenosis with tracheomalacia (1.41%), foreign body (1.41%), tracheomalacia (1.41%), and laryngeal papillomatosis (1.41%). Conclusion: Every child with stridor should be approached in specified protocol and causes should be evaluated.
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