PURPOSE: To compare success rates of intubation for 2 versus 5 months in congenital nasolacrimal duct obstruction in children between 15 and 30 months of age. METHODS: This prospective, randomized study evaluated drainage function in 145 eyes of children aged between 15 and 30 months and treated for congenital nasolacrimal duct obstruction using silicone stents with the fluorescein dye disappearance test. The tubes were removed 2 months (group I, 48 eyes) and 5 months (group II, 47 eyes) after stent placement. Thereafter, the children were followed for 6 months after tube removal. Fifty eyes were excluded from the study because of incomplete follow-up. RESULTS: The full resolution of symptoms (fluorescein test 0-1) was 33 of 48 in group I and 33 of 47 in group II at the time of tube removal (2 vs. 5 months). Six months after tube removal, the success rate was 43 of 48 (89.6%) in group I and 43 of 47 (91.5%) in group II. After the stents were removed, no relapses were observed in children having a fluorescein test 0-1 with the tubes remaining in the lacrimal system. CONCLUSIONS: The effects of intubation for 2 versus 5 months on the function of the nasolacrimal duct during and after intubation in children between 15 and 30 months of age are comparable. The fluorescein dye disappearance test is the test of choice for monitoring lacrimal drainage function.
- MeSH
- Time Factors MeSH
- Nasolacrimal Duct MeSH
- Fluorescein metabolism MeSH
- Fluorescent Dyes metabolism MeSH
- Intubation instrumentation methods MeSH
- Infant MeSH
- Humans MeSH
- Lacrimal Duct Obstruction congenital metabolism therapy MeSH
- Child, Preschool MeSH
- Prospective Studies MeSH
- Silicones MeSH
- Stents MeSH
- Treatment Outcome MeSH
- Check Tag
- Infant MeSH
- Humans MeSH
- Child, Preschool MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
BACKGROUND: To present experience with conjunctivocystorhinostomies (CDCR) at pediatric age. METHODS: Operative and postoperative data were collected for 15 pediatric CDCRs (aged 9 to 14.5 years) performed endonasally. Four procedures were performed bilaterally, seven unilaterally. The follow-up examinations were made every 3 months in the first year, every 6 months in the second year, and every 12 months afterwards. The patient s satisfaction with the surgery, lacrimal drainage function, and complications were evaluated. The drainage function of the lacrimal system was assessed on the basis of the history, clinical examinations, and the fluorescein dye disappearance test. The data were taken from the medical records and written questionnaires. RESULTS: After the surgery, 12 children were very satisfied, two children partially satisfied, and one child was not satisfied (due to the loss of the tube). Full or partial functional success was found in 14 cases (93.3%); no functional success was observed in one case. The number of complications was higher than in other studies concerning adult patients. A total of 37 complications were observed in our study; most of the complications occurred in more than one of the children, and were observed in some children several times. The most frequent complications were lateral or medial malposition (25 times) and the extrusion of the tube (eight times). It was necessary to re-insert the tube in seven cases under general anaesthesia. The complications mostly occurred within the first 3 months after the surgery (seven complications during the first week, 12 complications between the 2nd and the 4th week, eight complications between the 5th and the 12th week, and three complications between the 9th and the 12th postoperative week). CONCLUSIONS: CDCR appears to be a reasonable procedure in children over 10 years old. Experience in lacrimal surgery (pediatric dacryocystorhinostomy, CDCR in adults), and good cooperation and compliance of children are a fundamental assumption for successful pediatric CDCR.
- MeSH
- Dacryocystorhinostomy methods MeSH
- Child MeSH
- Nasolacrimal Duct surgery MeSH
- Intubation instrumentation methods MeSH
- Conjunctiva surgery MeSH
- Humans MeSH
- Adolescent MeSH
- Follow-Up Studies MeSH
- Lacrimal Duct Obstruction MeSH
- Intraoperative Complications MeSH
- Postoperative Complications MeSH
- Lacrimal Apparatus secretion MeSH
- Patient Satisfaction MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Anesthesia MeSH
- Child MeSH
- Intubation methods instrumentation MeSH
- Humans MeSH
- Check Tag
- Child MeSH
- Humans MeSH
Práce seznamuje se dvěma metodami selektivní intubace a ventilace dětských plic během anestezie pro torakoskopii či operační výkon v hrudní dutině. Jedná se o kombinaci endobronchiální a endotracheální intubace dvěma rourkami a o metodu obturace bronchu ošetřované plíce angioplas- tickým balónkovým katétrem. Obě metody splnily očekávání, tj. zajistily požadovaný kolaps ošetřované plíce a její eventuální izolaci. Parametry selektivní ventilace dětských plic vychází z hodnot běžné ventilace, potřebná korekce je minimální. Práce ukázala, že metoda s užitím obturace bronchu je perspektivnější, neboť je technicky méně náročná a použitelná i u dětí v předškolním věku.
The paper present two methods of selective intubation and ventilation of pediatric lungs during anesthesia for thoracoscopic or surgical procedures in thoracic cavity. One method is a combination of endobronchial and endotracheal intubation with two tubes; the other one implements obturation of bronchus of operated lung with angioplastic catheter balloon. Both methods meet the expectations i.e. the lung collapsed and could be eventually isolated. Parameters of selective pediatric lung ventilation are derived from the values for common ventilation, needs for correction are minimal. The paper shows that the method implementing bronchus obturation is more perspective because it is technically less demanding and could be used in pre-school children, too.
Poranění krku mohou ohrozit život poraněných hlavně neprůchodností dýchacích cest, jejichž zajištění často spadá do kategorie „difficult airways“. Sdělení se zabývá dělením poranění krku a typickými příznaky poranění, zejména s ohledem na možné poranění dýchacích cest. Adekvátní zajištění průchodnosti dýchacích cest při poranění krku zůstává urgentní prioritou. Je uveden přehled způsobů zajištění dýchacích cest, jejich výhody a úskalí. Ve třech kazuistikách jsou demonstrovány tři těžké případy poranění krku s popisem diagnostiky a léčebného postupu. Je zdůrazněna nutnost komplexní diagnostiky i při pouhém podezření na poranění dýchacích cest.
Neck injuries can become life-treating disease mainly thanks to a probable airways obstruction. Airway management in such cases ranks in the category of the „difficult airways“. This presentation deals with kinds of the neck injury, their typical symptoms, especially with regard to possible airways injury. Adequate airway management in patients with the neck injury remains the first priority. We present a survey of kinds of the airways management, their benefit and risk. Three case presentations of patients with severe neck injury are presented, including the diagnostic process and the therapy description. Necessity of a complex diagnostic process even in cases of suspected airways trauma is emphasized.
