A Rare Presentation of Acquired Laryngomalacia and Tracheomalacia in a Child Associated with Apricot Sulfurization

Sulfur fumigation has come to replace traditional sun drying methods for drying fruits over the years around the world as it is a cheaper and faster method because of its pesticidal and anti-bacterial properties. We report the case of an 11-year-old boy with acquired severe biphasic stridor who was exposed to extremely high concentrations of sulfur dioxide (SO2) during apricot sulfurization processes with his mother. The patient's bronchoscopy revealed severe glottic and subglottic damage. Exposure to SO2 is a health risk, particularly for individuals who are sulfide-sensitive, especially in childhood. The pulmonary epithelium may be directly injured by inhaled toxic substances at various levels of the respiratory system. To the best of our knowledge, this is the first case reported of acquired airway damage associated with sulfurization in a pediatric patient without a known history of any respiratory disease or symptoms

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Spontaneous Healing of Mandibular Noncontinuous Defect Caused by Medication-Related Osteonecrosis of the Jaw

Bayram, Cem/0000-0001-8717-4668; ATIL, Fethi/0000-0002-8286-4819WOS: 000378088800026PubMed: 27244207Background: Bisphosphonates are used throughout supportive cancer therapies for the treatment of osteoporosis and metastatic bone diseases, but they invariably induce medication-related osteonecrosis of the jaw (MRONJ). This medicational modality may induce consequential losses that can lead to spontaneous or surgical therapy related bone fractures or defects. MRONJ stages and treatment alternatives are described in the current procedures. Accordingly, treatments for stages 0 and 1 are conservative whereas the treatment for stage 3 is surgical resection of the necrotic bone. Stage III MRONJ therapy is still controversial within the scope of conceivable bone fractures or defects. When the development of MRONJ is refractory to conventional treatment modalities, surgical management can be suggested. The aim of this study was to evaluate the results of the surgical treatment of MRONJ as part of a medical patient. Methods: A 72-year-old man was referred to our department for extensive pain of the left mandibular region that occurred after tooth extraction. It was identified in his medical history that he had received a nitrogen-containing intravenous bisphosphonate (Zometa; Novartis, East Hanover, NJ) therapy for prostate cancer. He had been administered 4 mg. IV Zolenat 9 times during the first year of therapy, followed by 2 doses of the same amount of Zolenat in the second year. Results: The treatment started with a therapy that combined antibiotics and antibacterial mouth rinse with chlorhexidine for maintaining oral hygiene. After the maturity of the sequestrum was identified through radiographic examination, the patient was treated by the segmental resection of the extensive necrotic bone, resulting in discontinuity of the mandibular corpus. Two years later, spontaneous bone healing occurred along the residual defect on the mandible. Conclusion: Treatment options for the defects resulting from MRONJ are still under debate, and no evidence-based guidelines are available. However, due to the results displayed in this patient; it may be a sound approach to closely follow up and observe MRONJ-related bone to prevent additional complications

A Rare Cause of Pulmonary Hypertension in a 4-Year-Old Toddler: Association of Cor Triatriatum Sinister and Pulmonary Arteriovenous Malformation

Cor triatriatum sinister is a rare congenital cardiac anomaly. The anomaly is caused by a fibromuscular membrane that divides the left atrium into two cavities. This membrane can lead to the obstruction of left atrial flow and also create pulmonary venous hypertension. Pulmonary arteriovenous malformation (PAVM) is notorious for its aberrant blood flow between the pulmonary arteries and veins. Herein, we report a case of a 4-year-old toddler who had a unique form of pulmonary hypertension presenting with cor triatriatum sinister and diffuse PAVM. After the surgical treatment of cor triatriatum sinister, both pulmonary arteriovenous malformation and pulmonary hypertension disappeared

Psychiatric comorbidity in children with psychogenic and functional breathing disorders

Background The present study aims to assess psychiatric diagnoses in children with psychogenic and functional breathing disorders (PFBD), which consist of children with psychogenic cough, throat-clearing tics, and sighing dyspnea, and compare them to a control group without any diagnosis of chronic medical problems. Methods The participants consist of 52 children with PFBD and 42 children without any chronic medical problems. Psychiatric diagnoses were assessed via semistructured psychiatric interviews in both groups. Results The two groups did not differ on age (PFBD group 11.25 +/- 2.61, control group 11.17 +/- 2.58; t = 0.14, P = .88) or sex (48.1% of the PFBD group were female, 61.9% of the control group were female; chi(2) = 1.79, P = .18). 55.8% of the PFBD group and 28.6% of the control group had at least one psychiatric diagnosis according to the semistructured interviews (chi(2) = 6.99, P = .008). The most common psychiatric diagnoses in the PFBD group were attention deficit hyperactivity disorder (ADHD; 17.3%), tic disorders, (15.4%), and specific phobia (15.4%). 11.5% of the cases in the PFBD group were diagnosed with somatic symptom disorder and more than half of the patients (n = 27 (51.9%)) showed clinical characteristics of tic disorders. Conclusion Psychiatric diagnoses are common in children with PFBD, and teamwork involving child psychiatrists may be essential for the management of children with PFBD

Psychiatric comorbidity in children with psychogenic and functional breathing disorders

Background The present study aims to assess psychiatric diagnoses in children with psychogenic and functional breathing disorders (PFBD), which consist of children with psychogenic cough, throat-clearing tics, and sighing dyspnea, and compare them to a control group without any diagnosis of chronic medical problems. Methods The participants consist of 52 children with PFBD and 42 children without any chronic medical problems. Psychiatric diagnoses were assessed via semistructured psychiatric interviews in both groups. Results The two groups did not differ on age (PFBD group 11.25 +/- 2.61, control group 11.17 +/- 2.58; t = 0.14, P = .88) or sex (48.1% of the PFBD group were female, 61.9% of the control group were female; chi(2) = 1.79, P = .18). 55.8% of the PFBD group and 28.6% of the control group had at least one psychiatric diagnosis according to the semistructured interviews (chi(2) = 6.99, P = .008). The most common psychiatric diagnoses in the PFBD group were attention deficit hyperactivity disorder (ADHD; 17.3%), tic disorders, (15.4%), and specific phobia (15.4%). 11.5% of the cases in the PFBD group were diagnosed with somatic symptom disorder and more than half of the patients (n = 27 (51.9%)) showed clinical characteristics of tic disorders. Conclusion Psychiatric diagnoses are common in children with PFBD, and teamwork involving child psychiatrists may be essential for the management of children with PFBD

Ameloblastik fibroma: İki olgu sunumu

Ameloblastik fibroma epitelyal ve ektomezenşimal komponentler içeren, genellikle 2. dekatta görülen ve nadir karşılaşılan benign bir odontojenik tümördür. Bu makalede 14 yaşındaki erkek ve 20 yaşındaki bayan hastada mandibular posterior bölgede rutin dental kontroller sırasında farkedilen lezyonlar konservatif enükleasyon ile çıkarılmış olup, hastalar nüks açısından düzenli takibe alınmıştır. Bu vaka raporunda ameloblastik fibroma olgusu, klinik, radyografik ve histopatolojik olarak anlatılmakta, ayrıca nüks ihtimali ve tedavi protokolü arasındaki ilişki literatür bilgisi altında tartışılmaktadı

Effects of Long-Term Pamidronate Treatment on Bone Density and Fracture Rate in 65 Osteogenesis Imperfecta Patients

Objective: Osteogenesis imperfecta (OI) is a clinically and genetically heterogeneous disease characterized by recurrent fractures, blue sclera, and hearing loss. Bisphosphonate treatment has been reported to decrease the annual number of fractures and improve the quality of life in patients with OI. The aim of this study is to evaluate the effect of bisphosphonate treatment in the Turkish OI cohort