A Fatal Cause for a Common Presentation

Abstract

Upper airway obstruction in the pediatric population has a myriad of etiologies, some of which are easily overseen. We emphasize the importance of thorough airway examination and careful attention to unusual signs, which, in this case, uncovered a fatal tumor. BACKGROUNDAdenotonsillar hypertrophy (AH) and its sequelae in the pediatric population have been considered for well over 100 years. In 1889, it was suggested that obstruction of the upper airway in such affected children caused "backwardness and stupidity." 1 We now have a greater understanding of the neurobehavioral abnormalities seen in obstructive sleep apnea (OSA) that Hill was referring to. Moreover, the many other sequelae of OSA seen in adults (namely, cardiovascular, and metabolic effects) have also been demonstrated in children. 2 The collection of sleep-related airway problems encountered in childhood (snoring, sleep disordered breathing (SDB) and OSA) do not always present with obvious structural airway obstruction 2 and nor is a seemingly obvious airway obstruction in these patients always the root cause of the problem. The pathogenesis of these disorders is more complex and multifactorial. Only 71% of 110 children with OSA and AH who underwent adenotonsillectomy had successful remission of OSA. 3 Obesity, craniofacial abnormalities, neuromuscular disorders, exposure to smoking, and prematurity contribute to the pathogenesis of SDB. 2 IJHNS CaSe RepoRt

Perspectives on health care reform and the Affordable Care Act

“…129 Instead of exploring the most controversial or substantively significant subjects regarding the ACA's passage, Emanuel writes about certain topics because he ''was engaged on these issues'' at the OMB. 130 His examination of the tax exclusion and ''Cadillac tax'' on high-end insurance plans then morphs into a review of Emanuel's significant influence (in his own eyes): he seized ''the opportunity [in a meeting with President Obama] to argue for altering the tax exclusion''; 131 he then presented the notion that the president had not previously heard, that ''the tax exclusion was the single-most effective instrument the president possessed to control and reduce private-sector health costs''; 132 and, ultimately he articulated the ''good policy rationales in favor of cost control-not revenue generation-[that] overcame the president's past statements.'' 133 Emanuel concludes, again without providing any citations or evidence, that the Cadillac tax he promoted has started achieving its objective even prior to implementation as insurers and employers proactively take action to avoid the tax.…”