Abstracts of staff publications
aFall 1998
Wheezing or stridor:
Intrinsic and extrinsic lesions causing noisy breathing
Peter Michelson and Susanna McColley
From the Division of Pulmonary and Critical Care Medicine, Department of Pediatrics, Children's Memorial Hospital and Northwestern University Medical School, Chicago.
Allergy and Asthma Proceedings 1998;19:81–84
Noises that occur during both inspiration and expiration (biphasic stridor or wheezing) arise from lesions in the trachea, which is dynamically affected by both inspiratory and expiratory forces, or by critical airway narrowing at any site.
A number of conditions, from vocal cord paresis to vascular ring, can present as persistent or recurrent wheezing, refractory to bronchodilator and corticosteroid therapy. A careful history and physical examination, with careful attention to the timing of the respiratory noise, will facilitate the diagnosis. Furthermore, referral for radiologic examination and, as indicated, endoscopic evaluation, will confirm the diagnosis in most cases, allowing for initiation of appropriate therapy.
Differential effect of ecologic risk factors on the low birthweight components of African-American, Mexican-American, and non-Latino white infants in Chicago
James Collins, Jr., Nancy Schulte, and Aimee Drolet
From the Department of Pediatrics, Children's Memorial Hospital and Northwestern University Medical School, Chicago, and the Anderson School of Management, University of California, Los Angeles.
Journal of the National Medical Association 1998;90:223–229
This study explored the relationship between ecological risk factors and infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and white infants born in Chicago in 1990. One half of African-American mothers (n = 26,799) resided in communities with multiple ecologic risk factors, yet their very low birthweight rates were unaffected by the number of these factors. By contrast, only 5% of Mexican-American mothers (n = 9913) and 5% of white mothers (n = 13,596) lived in communities with multiple ecologic risk factors. Their very low birthweights were twi;ce that of infants born to mothers who resided in communities with no ecologic risk factors. These results indicate that ecologic risk factors affect the very low birthweight rates of Mexican-Americans and whites but not African Americans.
Exanthems in childhood: An update
Anthony Mancini
From the Division of Dermatology, Department of Pediatrics, Children's Memorial Hospital and Northwestern University Medical School, Chicago.
Pediatric Annals 1998;27(3):163–170
Infectious exanthems are common in childhood and are responsible for a significant proportion of patient visits to a pediatric office. Their expressions range from non-specific rashes to eruptions with a distinct distribution and/or lesional morphology. Many exanthems are limited primarily to the skin while others may suggest potential systemic associations, making their recognition and proper categorization vital. The importance of prompt recognition and diagnosis is further compounded by the epidemiology of some exanthematous diseases, such as exposure of a pregnant woman to rubella or parvovirus, or the diagnosis of varicella in a hospitalized patient who is in close proximity to immunocompromised individuals.
Repair of congenital tracheal stenosis with a free tracheal autograft
Carl Backer, Constantine Mavroudis, Michael Dunham, and Lauren Holinger
From the Divisions of Cardiovascular-Thoracic Surgery and Otolaryngology, Children's Memorial Hospital, and the Departments of Surgery and Otolaryngology-Head and Neck Surgery, Northwestern University Medical School, Chicago.
Journal of Thoracic and Cardiovascular Surgery 1998;115:869–874
Objectives: Evaluate the results of a technique for repair of congenital tracheal stenosis by use of a free tracheal autograft.
Methods: Between January 1996 and July 1997, six infants with congenital tracheal stenosis resulting from complete tracheal rings underwent repair with a free tracheal autograft. Mean age at the time of repair was 4.9 months; mean weight was 5.4 kg. The approach was through a median sternotomy with cardiopulmonary bypass for respiratory support. The trachea was incised anteriorly through the area of stenosis, the midportion of the stenotic trachea was excised, and an end-to-end anastomosis was carried out posteriorly. The excised tracheal segment (1.3 to 2.2 cm long) was used as a free autograft to patch the lower trachea anteriorly. In four infants the autograft was augmented in the upper trachea with pericardium; in two patients with a shorter length of stenosis, the autograft completed the repair. Simultaneous pulmonary artery sling repair (4), ligation and division of patent ductus arteriosus (3), cricoid split (2), atrial and ventricular septal defect repair (1), and complete atrioventricular canal repair (1) were performed at the time of a tracheal repair.
Results: The infants were extubated and discharged at a mean of 13 and 23 days postoperatively, respectively. One infant had recurrent tracheal stenosis related to the pericardial patch and required a tracheal stent and tracheostomy 4 months postoperatively. Our mean follow-up is 11 months. Bronchoscopic findings currently show widely patent tracheal lumina in all infants.
Conclusions: The technique of free tracheal autograft with and without pericardial augmentation was successful in opening the airway of six infants with congenital tracheal stenosis and is currently our procedure of choice for children with this diagnosis.
