Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

Purpose: Prolonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors. Methods: 150 children, aged 0–16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed. Results: The median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due t

Xanthoma in the external acoustic meatus

Objectivesa unique case of a xanthoma in the external ear canal of a pediatric patient is presented in this case report. We describe and resume the current literature on xanthomas in the head and neck area.Methodsclinical and intraoperative findings are reported and the presumed mechanisms for the emergence of xanthomas are discussed. We furthermore described the pathologic and immunohistochemical characteristics.Resultsxanthomas are mostly seen in patients with lipid metabolism disorders or hyperlipidemia. However, they can be present in normolipemic patients and are also associated with hematologic disease. Literature on the existence of xanthomata in the head and neck area is rare and there are no case reports in the pediatric population to the best of our knowledge. Besides the clinical presentation, characteristic histopathological features can confirm the diagnosis. When features are overlapping, immunohistochemistry can be necessary.Conclusionsince different subtypes of xanthoma have specific clinical and histopathological features and are assoc

Indications and clinical outcome in pediatric tracheostomy

Objective: Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years. Methods: We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed. Results: Our research

Dual sympathetic and parasympathetic hypothalamic output to white adipose tissue

The balance of lipogenesis and lipolysis in fat tissue is regulated both by the interaction of blood born factors and by the autonomic nervous system (ANS). The sympathetic branch stimulates lipolysis, whereas its antagonist, the parasympathetic branch, promotes lipogenesis. Here, by applying two different strains of the retrograde transneuronal tracer Pseudorabies Virus (PRV), we describe a hypothalamic network proximal to the two branches of the ANS. After an injection of PRV-Bartha-80 (PRV-B-80) into the right, sympathetically denervated, retroperitoneal fat pad and a simultaneous injection of PRV-Bartha-GFP (PRV-B-GFP) into the left, parasympathetically denervated, retroperitoneal fat pad we could trace both branches of the ANS up to the hypothalamus within the same animal. We found that pre-autonomic neurons in the suprachiasmatic nucleus (SCN), the paraventricular nucleus of the hypothalamus (PVN) and the lateral hypothalamus (LH) are specialized to project either to sympathetic or to parasympathetic motor neurons. Interestingly, the neurons projecting to these separate autonomic systems share the same brain nuclei. This dual hypothalamic pathway enables hypothalamic centers, such as the biological clock together with temperature and feeding centers, to coordinate metabolic and endocrine functions of adipose tissue.