Endoscopic findings in children with stridor.

SummaryCongenital and acquired airway diseases are responsible for upper respiratory distress and stridor in children. In neonatal intensive care units, we have seen increased survival in premature babies, but also a high incidence of airway complications related to intubation, which present as stridor.AimTo review endoscopic findings in children with stridor.Study designa cross-sectional cohort study.MethodsA retrospective analysis was done of 55 cases of children with stridor who underwent endoscopic exams, between January 1997 and December 2003.Results69% were aged below one year. The main indications for endoscopy were post-extubation stridor (63.63%) and evaluation of neonatal stridor (21.82%). Many associated diseases were seen, including lung diseases (60%), neurological condition (45.4%), and GERD (40%). The main endoscopic findings and indications for tracheotomy were subglottic stenosis (27.27%) and airway inflammatory process (21.82%) occurring in children under five years old. Congenital disorders were more frequent in children under age one year.ConclusionNeonatal stridor has many causes; those related to tracheal intubation are more frequent in hospitals that treat more complex diseases. Pediatricians and otorhinolaryngologists should know the main causes of stridor and perform detailed clinical evaluations to determine case severity. The endoscopic examination, must be meticulous

Complicações das vias aéreas relacionadas à intubação endotraqueal

Descrevemos as principais complicações das vias aéreas relacionadas à intubação endotraqueal, por meio de revisão da literatura e apresentação dos resultados de pesquisas clínicas e experimentais realizadas pelo nosso grupo de estudo. Procuramos alertar os profissionais de saúde quanto à alta incidência de complicações secundárias à intubação, as quais podem ser reduzidas com a adoção de medidas profiláticas simples e de cunho prático, estabelecidas após a compreensão da fisiopatologia das lesões.We reviewed the main airway complications associated with endotracheal intubation, presented some results of our researches and alert health professionals for the high incidence of airway injuries. The knowledge of the physiopathology of these injuries will help to proper prophylactic and practice conducts to prevent the airway complications associated with endotracheal intubation

Tireóide ectópica cervical lateral: Relato de caso e revisão da literatura

Tireóide ectópica é qualquer tecido tireoideano localizado fora de sua topografia habitual, podendo apresentar-se na linha mediana do pescoço ou, mais raramente, na região cervical lateral. Algumas teorias tentam explicar a origem do tecido tireoideano ectópico: 1. falha na descida da glândula; 2. seqüestro de nódulos tireoideanos; 3. presença de tecido tireoideano na cápsula de linfonodos cervicais; 4. formação teratomatosa; 5. Secundário a anomalias branquiais. Na abordagem diagnóstica, diversos exames têm sido utilizados, sendo o diagnóstico definitivo algumas vezes fornecido apenas pelo estudo histopatológico. Apesar das controvérsias em relação às abordagens terapêuticas apresentadas na literatura, é necessário um planejamento rigoroso para evitar iatrogenias. Conclui-se que a presença de tecido tireoideano ectópico deve ser lembrada no diagnóstico diferencial de massas cervicais laterais, e sua origem histológica considerada, sendo na maioria das vezes metástase de um carcinoma tireoideano oculto. Os autores relatam um caso de tecido tireoideano ectópico lateral no pescoço, em paciente do sexo feminino com bócio colóide mergulhante. Foram realizadas considerações importantes sobre dismorfogênese tireoideana, métodos diagnósticos e opções de tratamento, com revisão da literatura das últimas cinco décadas.Ectopic thyroid is any thyroid tissue located outside its normal topography, which may present itself along the median line of the neck or, more rarely, in the lateral cervical region. Some theories seek to explain the origin of ectopic thyroid tissue as: 1. Failure in descent of the gland; 2. Occlusion of thyroid nodules; 3. Presence of thyroid tissue in the cervical lymph node capsules; 4. Teratomatous formation; 5. Secondary to branchial anomalies. For diagnosis, a number of exams have been used, the definitive diagnosis sometimes being provided only by a histopathological study. Despite the controversies in relation to therapeutic approaches presented in the literature, rigorous planning is necessary in order to avoid iatrogenias. It is concluded that the presence of ectopic thyroid tissue should be remembered upon diagnosis of differential lateral cervical masses, and its histological origin considered, it most often being metastasis of an occluded thyroid carcinoma. The authors present a case of ectopic lateral neck thyroid tissue, in a woman aged 42 with atoxic multinodular goiter. Important considerations were accomplished about the theories to explain the origin of ectopic thyroid tissue, diagnostic methods and treatment options, reviewing the literature of the last five decades